高位退变性腰椎滑脱斜外侧腰椎间融合椎弓钉固定

Oblique lumbar interbody fusion combined with pedicle screw fixation for upper degenerative lumbar spondylolisthesis

摘要:

［目的］评价斜外侧腰椎间融合术（oblique lumbar interbody fusion, OLIF）联合 Wiltse 入路椎弓根钉固定治疗高位退变性腰椎滑脱症的临床疗效。［方法］回顾性分析 2018 年 3 月—2019 年 6 月本院手术治疗的高位退变性腰椎滑脱症 43 例患者的临床资料。根据医患沟通结果，20 例采用 OLIF 联合 Wiltse 入路椎弓根钉固定治疗（OLIF 组），23 例采用经椎间孔腰椎间融合术（transfo- raminal lumbar interbody fusion, TLIF）（TLIF 组）治疗。比较两组围手术期、随访及影像资料。［结果］所有患者均顺利完成手术， OLIF 组在手术时间、切口长度、术中失血量、术后引流量、下地行走时间和术后住院时间上均显著优于 TLIF 组（P<0.05）。所有患者均获随访 12 个月以上，平均随访（22.70±6.51）个月。OLIF 组完全负重活动时间显著早于 TLIF 组（P<0.05）。随时间推移，两组 VAS、ODI 评分均显著减少（P<0.05），而 JOA 评分显著增加（P<0.05）。相应时间点，两组间 VAS、ODI 及 JOA 评分的差异均无统计学意义（P>0.05）。影像方面，与术前相比，末次随访时两组患者椎间隙高度、椎间孔高度、腰椎前凸角均显著增加（P<0.05）；而椎体滑脱率均明显减少（P<0.05）。术后 3、6 个月和末次随访时，OLIF 组 Lenke 椎间融合评级均显著优于 TLIF 组（P<0.05）。［结论］相较于 TLIF 术，OLIF 联合 Wiltse 入路椎弓根钉固定治疗高位退变性腰椎滑脱症具有医源性创伤小、恢复快、术后并发症少等优点。

Abstract:

[Objective] To evaluate the clinical outcomes of oblique lumbar interbody fusion (OLIF) combined with pedicle screw fixa- tion through Wiltse approach for upper degenerative lumbar spondylolisthesis. [Methods] A retrospective study was done on 43 patients who received surgical treatment for upper degenerative lumbar spondylolisthesis in our hospital from March 2018 to June 2019. Based on preoperative doctor-patient communication, 20 patients were treated with OLIF combined with pedicle screw fixation through Wiltse ap- proach (the OLIF group) , while the other 23 patients underwent transforaminal lumbar interbody fusion (the TLIF group) . The periopera- tive, follow-up and imaging data of the two groups were compared. [Results] All patients had operation finished successfully, with the OLIF group significantly superior to the TLIF group in terms of operation time, incision length, intraoperative blood loss, postoperative drainage, postoperative walking time and hospital stay (P＜0.05) . All patients were followed up for more than 12 months, with a mean of (22.70±6.51) months. The OLIF group resumed full weight-bearing activity significantly earlier than the TLIF group (P＜0.05) . The VAS and ODI scores decreased significantly (P＜0.05) , while JOA score increased significantly in both groups over time (P＜0.05) . At any corresponding time points, no significant differences in VAS, ODI and JOA scores were noticed between the two groups (P＜0.05) . Radiographically, interverte- bral space height, intervertebral foraminal height, and lumbar lordosis angle significantly increased (P＜0.05) , whereas the slippage degree of vertebral body decreased significantly in both groups at the latest follow- up compared with those preoperatively (P＜0.05) . The OLIF group proved significantly superior to the TLIF group in term of Lenke interbody fusion scale at 3 months, 6 months and the latest follow-up (P＜0.05) . [Conclusion] OLIF combined with pedicle screw fixation through Wiltse approach has advantages of minimizing iatrogenic trau- ma, enhancing recovery and reducing postoperative complications over the TLIF for treatment of upper degenerative spondylolisthesis.