摘要
目的比较斜侧方椎间融合术（OLIF）和经椎间孔椎间融合术（TLIF）在手术时间、出血量、临床效果和术后矢状面前凸恢复等方面的差异。方法采用回顾性病例对照研究分析2016年1月至2017年12月浙江大学邵逸夫医院收治的OLIF和TLIF病例共73例。其中男31例，女42例；年龄36-88岁，平均65．8岁。腰椎间盘突出症伴钙化9例，腰椎管狭窄症34例，退变性腰椎滑移症17例，退变性腰椎侧凸症12例，腰椎峡部裂性滑移症1例。按手术方式为分OLIF组（34例）和TLIF组（39例）。记录比较两组手术时间、术中出血量及是否输血，手术前后疼痛视觉模拟评分（VAS）及Oswestry功能障碍评分（ODI），并测量术前和术后腰椎前凸角（LL）和融合节段前凸角（FSL）。组间比较采用Studentt检验。结果OLIF组有10例（29．4％）使用后路固定，TLIF组全部39例（100％）均使用后路固定（X。=41．013，P〈0．05）。OLIF组手术时间和术中出血量显著小于TLIF组[（163±68）比（233±79）min、（116±148）比（434±201）ml，t=4．019、6．964，均P〈0．05]。OLIF!且和TLIF组在手术后VAS及ODI下降分值差异均无统计学意义（t＝1．716、0．522，均P〉0．05）。OLIF组LL恢复4．0°±10．0°，TLIF组为4．2°±6．1°；OLIF组FSL恢复4．1°±7．0°，TLIF组为5．2°±4．6°，差异均无统计学意义（t=0．139、0．805，均P〉0．05）。使用后路固定的OLIF组LL恢复显著大于TLIF组（9．9°±11．1°比4．2°±6．1°，t=2．180，P〈0．05）。结论OLIF和TLIF都能一定程度上恢复腰椎前凸，但OLIF在手术时间和术中出血量上有明显优势。同时，在加用后路固定的情况下，OLIF对前凸矫正的效果比TLIF更好。
Objective To compare the operation time, estimated blood loss, clinical outcome and correction of lumbar lordosis between oblique lateral interbody fusion （ OLIF ） and transforaminal lumbar interbody fusion （TLIF） in patients with degenerative lumbar diseases. Methods Seventy-three patients who underwent OLIF or TLIF surgery from January 2016 to December 2017 in Sir Run Run Shaw Hospital Zhejiang University were analyzed in this retrospective case-control study. The patients included 3l males and 42 females, with a mean age of 65.8 years （range, 36 -88 years）. Of the patients, there were 9 eases of calcified disc herniation, 34 eases of spinal stenosis, 17 cases of degenerative spondylolithesis, 12 cases of degenerative scoliosis and 1 case of isthmic spondylolithesis. According to the type of surgery, patients were divided into OLIF group （34 cases） and TLIF group （39 cases）. The operation time, estimated blood loss and transfusion were recorded, pre-and post-operative visual analogue scale （VAS） for back pain and Oswestry Disability Index （ODI） were evaluated, and pre- and post-operative lumbar lordosis （EL） and fused segment lordosis （FSL） were measured. Student t test were used in comparison between groups.Results Ten （29.4%） patients in OLIF group and all 39 （100%） patients in TLIF group were supplemented with posterior instrumentation （ X2 = 41. 013, P 〈 0.05 ） . The average operation time and estimated blood loss was significantly lower in OLIF group than in those in TLIF group [ （ 163 ± 68 ） vs （233±79） Inin, （116 ±148） vs （434 ±201） ml, t=4.019, 6.964, both P〈0.05]. There was no significant differences in decreases value in VAS and ODI after surgery between the two groups （ t = 1. 716, 0. 522, both P 〉0. 05）. The correction of LL was 4. 0° ± 10. 0° in the OLIF group and 4. 2° ±6. 1° in the TLIF group; the correction of FSL was 4. 1° ±7.0° in the OLIF group and 5.2°±4. 6° in the TLIF group, with no significant differences between the two groups too （t = 0. 139, 0. 805, both P 〉 0.05 ）. The correction of LL was significantly higher in OLIF group with posterior instrumentation than that in TLIF group （9. 9° ± 11.1 ° vs 4. 2° ± 6. 1 °, t = 2. 180, P 〈 0. 05）. Conclusions Both OLIF and TLIF can restore LL to some extent, but OLIF has obvious advantages in the operation time and blood loss during surgery. When supplemented with posterior instrumentation, OLIF can achieve better correction of LL than TLIF.
作者
陈意磊
朱志海
王玉康
范顺武
方向前
万双林
张建锋
赵兴
赵凤东
Chen Yilei;Zhu Zhihai;Wang Yukang;Fan Shunwu;Fang Xiangqian;Wan Shuanglin;Zhang Jianfeng;Zhao Xing;Zhao Fengdong(Department of Orthopedics, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou 310016, China)
出处
《中华医学杂志》
CAS
CSCD
北大核心
2018年第25期1990-1995,共6页
National Medical Journal of China
关键词
腰椎退变
斜侧方椎间融合术
经椎间孔椎间融合术
前凸
Degenerative lumbar diseases
Oblique lateral interbody fusion
Transforaminallumbar interbody fusion
Lordosis
