腰椎退变性疾病斜外侧与微创经椎间孔椎间融合比较△（开放获取）

Oblique lateral interbody fusion versus minimally invasive transforaminal lumbar interbody fusion for lumbar degenerative diseases

摘要:

[目的] 对比斜外侧椎间融合术 （oblique lateral interbody fusion, OLIF） 和微创经椎间孔椎间融合术 （minimally inva- sive transforaminal lumbar interbody fusion, MI-TLIF） 治疗腰椎退变性疾病的临床疗效。[方法] 回顾性分析 2020 年 6 月—2021 年 6 月手术治疗的 64 例腰椎退变性疾病患者的临床资料，根据医患沟通结果，30 例行导航下单体位斜外侧椎间融合术（OLIF 组），34 例行微创经椎间孔椎间融合术 （MI-TLIF 组）。比较两组围手术期、随访和影像资料。[结果]OLIF 组手术时间 [min, (115.3±12.1) vs (150.6±16.8), P＜0.001]、下地行走时间 [d, (1.9±0.6) vs (3.2±0.7), P＜0.001] 及术后住院时间 [d, (5.6±0.8) vs (6.1±0.9), P= 0.022] 均显著少于 MI-TLIF 组，但切口长度 [cm, (11.4±1.6) vs (7.4±1.2), P＜0.001] 显著大于 MI-TLIF 组。随访时间（14.8±2.3）个月，OLIF 组恢复完全负重活动时间显著早于 MI-TLIF 组 [d, (26.4±3.2) vs (46.4±4.1), P＜0.001]。随时间推移，两组患者腰腿痛 VAS 评分、ODI 和 JOA 评分均明显改善（P＜0.05），术后 3 个月，OLIF 组腰痛 VAS 评分 [分, (3.1±0.9) vs (3.9±0.8), P＜0.001]、JOA 评分 [分, (17.8±1.8) vs (16.5±1.6), P=0.003] 显著优于 MI-TLIF 组。影像方面，与术前相比，末次随访时两组椎管面积、椎间隙高度及腰椎前凸角均显著增加（P＜0.05）。末次随访时，OLIF 组椎间隙高度 [mm, (10.9±1.5) vs (8.9±1.5), P＜0.001] 及腰椎前凸角 [°, (43.2± 5.8) vs (39.7±7.4), P=0.038] 显著优于 MI-TLIF 组，但两组椎管面积及 Bridwell 融合等级的差异均无统计学意义 （P＞0.05）。[结论]OLIF 和 MI-TLIF 两种术式治疗腰椎退变性疾病均可获得满意的临床疗效，OLIF 具有手术时间短、术后恢复快及早期腰痛轻等优势，是一种更加微创的手术方式。

Abstract:

[Objective] To compare clinical efficacy of oblique lateral interbody fusion (OLIF) versus minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) in the treatment of lumbar degenerative diseases. [Methods] A retrospective study was conducted on 64 patients who received lumber fusion for lumbar degenerative diseases from June 2020 to June 2021. According to the doctor-patient communication, 30 patients underwent navigational unidirectional OLIF, while other 34 patients received MI-TLIF. The documents regarding peri-operative period, follow-up and imaging were compared between the two groups. [Results] The OLIF group was significantly superior to the MI-TLIF group in terms of operation time [min, (115.3±12.1) vs (150.6±16.8), P＜0.001], ambulation time [days, (1.9±0.6) vs (3.2±0.7), P＜ 0.001] and postoperative hospital stay [days, (5.6±0.8) vs (6.1±0.9), P=0.022], despite of the fact that the former had significantly longer incision than the latter [cm, (11.4±1.6) vs (7.4±1.2), P＜0.001]. The follow-up time was of (14.8±2.3) months, and the OLIF group resumed full weight bearing activity significantly earlier than the MI-TLIF group [days, (26.4±3.2) vs (46.4±4.1), P＜0.001]. As time went on, the VAS, ODI and JOA scores of patients in both groups were significantly improved (P＜0.05). The OLIF group was significantly better than the MI-TLIF group in low back pain VAS score [points, (3.1±0.9) vs (3.9±0.8), P＜0.001] and JOA score [points, (17.8±1.8) vs (16.5±1.6), P= 0.003] 3 months after surgery. As for imaging, the vertebral canal area, intervertebral height and lumbar lordosis angle were significantly increased in both groups at the last follow-up compared with those preoperatively (P＜0.05). At the last follow-up, the OLIF group had significantly greater intervertebral height [mm, (10.9±1.5) vs (8.9±1.5), P＜0.001] and lumbar lordotic angle [°, (43.2±5.8) vs (39.7±7.4), P=0.038] than the MI-TLIF group, although there were no significant differences in spinal canal area and Bridwell fusion grade between the two groups (P＞0.05). [Conclusion] Both OLIF and MI-TLIF achieve satisfactory clinical consequences in the treatment of lumbar degenerative diseases. OLIF is a more minimally invasive surgical technique with advantages of short operation time, quick postoperative recovery and mild early lumbago over the MI-TLIF