两种微创融合术治疗退行性腰椎滑脱的比较

Comparison of two minimally invasive lumbar fusion procedures for degenerative lumbar spondylolisthesis

摘要:

[目的]比较内镜经椎间孔腰椎间融合术（endoscopic transforaminal lumbar interbody fusion, E-TLIF）与斜外侧腰椎椎间融合术 （oblique lumbar interbody fusion, OLIF） 治疗退行性腰椎滑脱 （degenerative spondylolisthesis, DS） 的临床效果。[方法] 2019 年 4 月—2021 年 1 月本院手术治疗 82 例 DS 患者。根据术前医患沟通结果，41 例行 E-TLIF 术，41 例行 OLIF 术。 比较两组围手术期指标、随访及影像资料。[结果]两组患者均顺利完成手术，均未发生严重并发症。OLIF 组手术时间、切口总长度、术中失血量、术中透视次数、下地行走时间、住院时间均显著优于 E-TLIF 组（P＜0.05）。OLIF 组术后 1d 时 ESR、PCT、 β-EP 均显著低于 E-TLIF 组（P＜0.05）。随着时间推移，两组 VAS 评分、ODI 评分均显著减少（P＜0.05），JOA 评分均显著增加 （P＜0.05），术后 1 周、术后 3 个月时 OLIF 组 VAS 评分均显著低于 E-TLIF 组（P＜0.05），术后相应时间点，两组间 ODI、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，术后两组椎间隙高度、腰椎前凸角均显著增加（P＜0.05）。术后 3 个月、末次随访时 OLIF 组椎间隙高度、胸椎前凸角均显著高于 E-TLIF 组（P＜0.05）。相应时间点两组椎体滑脱率、Lenke 融合评级的差异无统计学意义（P＞0.05）。[结论] 两种手术方式治疗 DS 患者具有相似的治疗效果，但 OLIF 具有出血少、恢复快、 创伤小、对血清指标影响小的优势。

Abstract:

[Objective] To compare the clinical outcomes of endoscopic transforaminal lumbar interbody fusion (E- TLIF) versus oblique lumbar interbody fusion (OLIF) for degenerative spondylolisthesis (DS). [Methods] From April 2019 to January 2021, 82 patients with DS were surgically treated in our hospital. According to preoperative doctor-patient communication, 41 patients underwent E-TLIF, while the remaining 41 patients received OLIF. The perioperative, follow-up and imaging data were compared between the two groups. [Results] All patients in both groups had operation performed successfully without serious complications. The OLIF group proved significantly superior to the E- TLIF group in terms of operation time, total incision length, intraoperative blood loss, intraoperative fluoroscopy times, walking time and hospital stay (P＜0.05). In addition, the OLIF group had significantly lower ESR, PCT and β-EP than the E-TLIF group at 1 day after operation (P＜0.05). The VAS and ODI scores decreased significantly (P＜0.05), while the JOA scores significantly increased over time in both groups (P＜0.05). The OLIF group was marked significantly lower VAS score than the E-TLIF group at 1 week and 3 months af- ter operation (P＜0.05), whereas there were no significant differences in ODI and JOA scores between the two groups at any corresponding time points postoperatively (P＞0.05). In terms of imaging, the intervertebral space height and lumbar lordotic angle significantly increased in both groups after surgery compared with those preoperatively (P＜0.05), which in the OLIF group were significantly higher than those in the E-TLIF group at 3 months and latest follow-up (P＜0.05). There was no significant difference in vertebral slippage percentage and Lenke grade for intervertebral fusion between the two groups at corresponding time points (P＞0.05). [Conclusion] Both E-TLIF and OLIF are ef- fective treatment for DS. By comparison, the OLIF has advantages of less bleeding, faster recovery, less trauma, and less impact on serum markers over the E-TLIF.