腰椎退行性疾病两种融合术的并发症比较△（开放获取）

Comparison of complications of two types of lumbar fusion for lumbar degenerative diseases

摘要:

[目的] 对比后侧肌间隙入路通道下椎弓根螺钉固定经椎间孔椎间融合 （transforaminal lumbar interbody fusion, TLIF） 与腰椎斜外侧椎间融合 （oblique lateral interbody fusion, OLIF） 联合后路固定治疗腰椎退行性疾病的临床效果与并发症。 [方法]回顾性分析 2016 年 1 月—2018 年 12 月收治的 157 例腰椎退行性疾病患者的临床资料，根据医患沟通结果，81 例采用 TLIF，76 例采用 OLIF。观察并对比两组临床结果与并发症情况。[结果]两组手术时间、下地时间比较差异无统计学意义（P＞ 0.05），OLIF 组术中出血量 [(79.8±26.5) ml vs (258.2±49.9) ml, P＜0.05]、住院时间 [(7.4±0.8) d vs (9.3±1.0) d, P＜0.05] 显著少于 TLIF 组。随访时间平均（20.8±10.8）个月，与术前相比，末次随访时，两组腰痛、腿痛 VAS、ODI 评分均显著减少（P＜0.05），相应时间点，两组间上述指标的差异均无统计学意义（P＞0.05）。影像方面，与术前相比，两组患者末次随访时椎间隙高度、腰椎冠状面和矢状面 Cobb 角均显著改善（P＜0.05）。相应时间点，两组间上述影像指标的差异均无统计学意义（P＞0.05）。并发症方面， OLIF 组早期并发症发生率显著高于 TILF 组（34.2% vs 19.8%, P＜0.05）；但两组晚期并发症的差异无统计学意义（1.3% vs 1.2%, P＞ 0.05）。[结论]由于两种手术椎管减压方式、椎间融合入路、所用融合器大小和面积、植骨材料、融合器放置位置的不同，因而两组并发症发生率和构成不同。

Abstract:

[Objective] To compare the clinical outcomes and complications of transforaminal lumbar interbody fusion (TLIF) versus oblique lateral interbody fusion (OLIF) combined with pedicle screw fixation through posterior intermuscular channel approaches for degenerative diseases of the lumbar spine. [Methods] A retrospective study was conducted on 157 patients who underwent lumbar interbody fusion for lumbar degenerative diseases in our hospitals from January 2016 to December 2018. According to the doctor-patient communication, 81 patients received TLIF, while other 76 patients were treated with OLIF. The clinical documents, including complications, of the two groups were observed and compared. [Results] Although there were no significant differences in operation time and ambulation time between the two groups (P＞0.05), the OLIF groups proved significantly superior to the TLIF group in terms of intraoperative blood loss [(79.8±26.5) ml vs (258.2±49.9) ml, P＜0.05] and the hospital stay [(7.4±0.8) days vs (9.3±1.0) days, P＜0.05]. With time of follow-up lasted for (20.8± 10.8) months on an average, the VAS scores for lower back pain and leg pain, as well as ODI score were significantly reduced in both groups (P＜0.05), which was not statistically significant between the two groups at any time points accordingly (P＞0.05). Radiologically, intervertebral height, coronal and sagittal Cobb angle of lumbar spine significantly improved in both groups at the last follow-up compared with those preoperatively (P＜0.05), whereas which were statistically insignificant between the two groups at any time accordingly (P＞0.05). Regarding to complications, the OLIF group was significantly higher in term of early incidence than the TLIF group (34.2% vs 19.8%, P＜0.05), despite insignificant difference in late complication incidence between the two groups (1.3% vs 1.2%, P＞0.05). [Conclusion] The incidence and composition of complications are different between the two lumbar fusion due to differences in spinal canal decompression methods, interbody fusion approach, size and area of fusion cage used.