三种不同微创腰椎融合术治疗L<sub>4</sub>/L<sub>5</sub>退变性滑脱的临床疗效比较

作者	单位	邮编
宋昭君^*	遂宁市中心医院脊柱外科,四川遂宁,629000	629000
张智	成都市第五人民医院脊柱外科,四川成都,611100	611100
郑佳状	遂宁市中心医院脊柱外科,四川遂宁,629000	629000
汪凡栋	遂宁市中心医院脊柱外科,四川遂宁,629000	629000
冉茂波	遂宁市中心医院脊柱外科,四川遂宁,629000	629000
骆娟	遂宁市中心医院脊柱外科,四川遂宁,629000	629000
张凯^*	遂宁市中心医院脊柱外科,四川遂宁,629000	629000

摘要点击次数: 14

全文下载次数: 8

中文摘要:

目的比较MIS-TLIF、OLIF及Endo-TLIF三种微创腰椎融合手术治疗L₄/L₅退变性滑脱的临床疗效。方法回顾性分析2019年10月至2022年9月期间遂宁市中心医院181例L₄/L₅退变性滑脱接受微创腰椎融合术的患者资料，其中MIS-TLIF治疗58例（MIS-TLIF组），OLIF治疗55例（OLIF组），Endo-TLIF治疗68例（Endo-TLIF组）。临床评估包括手术时间、术中出血量、住院时间、切口引流量、手术并发症、腰痛视觉模拟评分（VAS-B）、腿痛视觉模拟评分（VAS-L）、功能障碍指数（ODI）等。影像学评估包括腰椎前凸角（LLA）、椎间盘高度（DH）和植骨融合率。结果所有患者随访18 ～ 36个月，平均（24.92±3.44）个月。三组患者术前ODI、VAS-B、VAS-L、LLA、DH及随访时间比较，差异无统计学意义（P＞0.05）。三组患者的并发症无统计学差异。与MIS-TLIF组及Endo-TLIF组相比，OLIF组的术中出血量显著减少，住院时间更短，切口引流量更低，差异有统计学意义（P＜0.05）。OLIF组术后3、6、12个月的VAS-B评分显著低于其他两组，差异有统计学意义（P＜0.05），末次随访时三组VAS-B评分比较，差异无统计学意义（P＞0.05）。Endo-TLIF组术后3、6个月的VAS-L评分显著低于其他两组，差异有统计学意义（P＜0.05）；术后12个月及末次随访时三组的VAS-L评分比较，差异无统计学意义（P＞0.05）。术后3、6个月时，OLIF组的ODI评分显著优于其他两组，差异有统计学意义（P＜0.05）；术后12个月及末次随访时三组的ODI评分比较，差异无统计学意义（P＞0.05）。术后6、12个月及末次随访时，OLIF组的LLA均优于其他两组，且LLA变化值显著低于其他两组，差异有统计学意义（P＜0.05）。术后6、12个月及末次随访时，OLIF组的DH优于其他两组且DH变化值显著低于其他两组，差异有统计学意义（P＜0.05）。术后6、12个月及末次随访时，OLIF组植骨融合率明显高于其他两组，差异有统计学意义（P＜0.05）。结论与MIS-TLIF及Endo-TLIF相比，OLIF具有术中出血量更少，住院时间更短，引流量更小，更能有效缓解腰痛及维持腰椎前凸角和椎间盘高度，以及术后植骨融合率更高等优点。

英文摘要:

Objective To evaluate the clinical effects of the transforaminal lumbar interbody fusion (MIS-TLIF), oblique lumbar interbody fusion (OLIF), and percutaneous endoscopic transforaminal lumbar interbody fusion (Endo-TLIF) on L₄/L₅ degenerative spondylolisthesis.Methods In this retrospective study, 58 patients with L₄/L₅ degenerative spondylolisthesis received MIS-TLIF (MIS-TLIF group), 55 patients received OLIF (OLIF group), and 68 patients received Endo-TLIF (Endo-TLIF group) between October 2019 and September 2022. We compared operative time, blood loss, drainage volume, hospital stay and complications, visual analog scale for back pain (VAS-B), visual analog scale for leg pain (VAS-L), and Oswestry Disability Index (ODI). We also performed imaging assessments, including lumbar lordosis angle (LLA), disc height (DH) and intervertebral fusion status.Results All patients were followed up for 18-36 months, with an average of (24.92±3.44) months. There were no significant differences in preoperative ODI, preoperative VAS-B, preoperative VAS-L, preoperative LLA, preoperative DH, or follow-up time. Patients who underwent OLIF had significantly less blood loss, a shorter hospital stay and a lower drainage volume, than those who underwent MIS-TLIF or Endo-TLIF (P<0.05). The VAS-B in the OLIF group significantly decreased significantly compared to the MIS-TLIF and Endo-TLIF groups at 3, 6 and 12 months postoperatively (P<0.05). The VAS-L in the Endo-TLIF group significantly decreased compared to that in the MIS-TLIF and OLIF groups at 3 and 6 months postoperatively (P<0.05). The ODI in the OLIF group was significantly better than that in the MIS-TLIF and Endo-TLIF groups at 3 and 6 months postoperatively (P<0.05). There were no statistically significant differences in the incidence of complications was found among the three groups. The LLA and DH changes were significantly lower in the OLIF group than in the other groups at 6, 12 months postoperatively and at final follow-up (P<0.05). The intervertebral fusion rate was significantly higher in the OLIF group than in the other groups at 6 and 12 months postoperatively and final follow-up (P<0.05).Conclusion In conclusion, although MIS-TLIF, OLIF, and Endo-TLIF techniques can effectively treat patients with L₄/L₅ degenerative spondylolisthesis, OLIF has more advantages, including less operative blood loss, a shorter hospital stay, a smaller drainage volume, efficacy for back pain, effective maintenance of lumbar lordosis angle and disc height, and a higher fusion rate. OLIF should be the preferred surgical treatment for patients with L₄/L₅ degenerative spondylolisthesis.

查看全文查看/发表评论下载PDF阅读器