特异性腰椎间隙感染两种入路病灶清除融合比较△

Comparison of two approaches for debridement and fusion of specific lumbar intervertebral space infection

摘要:

［目的］ 比较斜外侧椎体间融合术 （oblique lateral interbody fusion, OLIF） 与经椎间孔腰椎体间融合术 （transforami- nal lumbar interbody fusion, TLIF） 治疗单节段特异性腰椎间隙感染的临床结果。［方法］ 回顾性分析 2017 年 8 月—2020 年 8 月本院手术治疗 L_2~4单节段腰椎结核 （tuberculosis, TB） 和布氏杆菌病 （brucellosis, Br） 45 例患者的临床资料。根据医患沟通结果，20 例接受 OLIF 术，25 例接受 TLIF 术。比较两组围手术期、随访及辅助检查结果。［结果］ OLIF 组手术时间、术中出血量、术后引流量、住院时间均显著优于 TLIF 组 （P<0.05）；所有患者均获随访 12~24 个月，两组完全负重活动时间的差异无统计学意义 （P>0.05）。随时间推移，两组 VAS 评分、ODI 指数显著减少 （P<0.05），末次随访两组 VAS 评分差异无统计学意义 （P>0.05），但 OLIF 组 ODI 指数显著优于 TLIF 组 （P<0.05）。随时间推移两组 Frankel 分级均显著改善 （P<0.05），相应时间点两组间 Frankel 分级的差异均无统计学意义。辅助检查方面，两组患者出院前及末次随访时椎间隙高度、腰椎前突角显著增加 （P<0.05），而 CRP 和 ESR 显著降低（P<0.05）。两组患者均达到病灶愈合、骨性融合。［结论］OLIF 技术治疗单节段特异性腰椎间隙感染是安全、有效的，并且与 TLIF 后路手术相比，病灶易清除、创伤小、早中期疗效显著、康复快。

Abstract:

[Objective] To compare the clinical outcomes of oblique lateral interbody fusion (OLIF) versus transforaminal lumbar inter- body fusion (TLIF) in the treatment of single-level specific lumbar intervertebral space infection. [Methods] A retrospective study was done on 45 patients who underwent surgical treatments for single-segment tuberculosis (TB) or brucellosis (Br) involving L₂ to L₄ in our hos- pital from August 2017 to August 2020. According to doctor-patient communication results, 20 patients received OLIF, while the other 25 patients received TLIF. The consequences regarding to perioperative period, follow-up, radiographic checks and laboratory tests were com- pared between the two groups. [Results] The OLIF group was significantly superior to TLIF group in terms of operation time, intraoperative blood loss, postoperative drainage and hospital stay (P<0.05) . All patients were followed up from 12 months to 24 months, and there was no statistical significance in the time to resume full weight-bearing activity between 2 groups (P>0.05) . The VAS and ODI scores decreased significantly in both groups over time (P<0.05) . Although there was no significant difference in VAS score between the two groups at the latest follow-up (P>0.05) , the OLIF group proved better than the TLIF group in term of ODI score (P<0.05) . The Frankel index for neuro- logical function significantly improved in both groups over time (P<0.05) , whereas with no statistically significant difference between the two groups at any corresponding time points (P>0.05) . With respect to imaging and laboratory examinations, the height of intervertebral space and lumbar lordotic angle significantly increased (P<0.05) , while CRP and ESR significantly decreased postoperatively compared with those preoperatively (P<0.05) . All patients in both groups achieved lesions subsided and bony fusion by the time of latest follow up. [Conclusion] The OLIF is safe and effective for treatment of single-level specific lumbar intervertebral space infection, with benefits of eas- ier to remove lesions, less trauma and better curative results in early and middle stage over the TLIF.