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中华老年骨科与康复电子杂志

中华老年骨科与康复电子杂志 ›› 2021, Vol. 07 ›› Issue (06) : 345 -351. doi: 10.3877/cma.j.issn.2096-0263.2021.06.005

脊柱专题

斜外侧腰椎椎间融合术与经椎间孔椎间融合术治疗退行性腰椎侧凸疗效比较
潘玉军1, 时长江2, 穆怀昭3, 张义龙1,†()   
  1. 1. 067000　承德医学院附属医院脊柱外科
    2. 067000　承德医学院附属医院关节外科
    3. 067000　承德医学院附属医院创伤骨科
  • 收稿日期:2021-07-15 出版日期:2021-12-05
  • 通信作者: 张义龙
  • 基金资助:
    承德市科技计划项目(201801A050)

Comparison of Oblique Lateral Lumbar Interbody Fusion and Transforaminal Interbody Fusion for The Treatment of Degenerative Lumbar Scoliosis

Yujun Pan1, Changjiang Shi2, Huaizhao Mu3, Yilong Zhang1,†()   

  1. 1. Department of Spine Surgery, Affiliated Hospital of Chengde Medical College, Chengde 067000, China
    2. Department of Joint Surgery, Affiliated Hospital of Chengde Medical College, Hebeichengde 067000, China
    3. Department of Trauma department of orthopedics, Affiliated Hospital of Chengde Medical College, Chengde 067000, China
  • Received:2021-07-15 Published:2021-12-05
  • Corresponding author: Yilong Zhang
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潘玉军, 时长江, 穆怀昭, 张义龙. 斜外侧腰椎椎间融合术与经椎间孔椎间融合术治疗退行性腰椎侧凸疗效比较[J]. 中华老年骨科与康复电子杂志, 2021, 07(06): 345-351.

Yujun Pan, Changjiang Shi, Huaizhao Mu, Yilong Zhang. Comparison of Oblique Lateral Lumbar Interbody Fusion and Transforaminal Interbody Fusion for The Treatment of Degenerative Lumbar Scoliosis[J]. Chinese Journal of Geriatric Orthopaedics and Rehabilitation(Electronic Edition), 2021, 07(06): 345-351.

目的

探讨斜外侧腰椎椎间融合术（OLIF）与经椎间孔椎间融合术（TLIF）治疗退行性腰椎侧凸（DLS）的疗效差异。

方法

回顾性分析2017年2月至2019年2月我院收治的DLS患者134例，根据不同手术方式分为OLIF组（64例）和TLIF组（70例）；比较两组患者的手术相关指标、并发症发生情况、融合率。分别于术前、术后6个月、2年评价视觉模拟评分（VAS）、Oswestry功能障碍指数（ODI），计算冠状位、矢状位Cobb角、腰椎前凸角、骶骨倾斜角、骨盆入射角。

结果

134例患者均获得完整随访，随访率100%，随访时间（35±4）个月。OLIF组手术时间[（243±39）min]显著高于TLIF组[（215±29）min，t=3.432，P=0.001]，OLIF术组术中出血量[（411 ± 34）ml]显著低于对照组[（653 ± 42）ml，t=4.865，P< 0.001]；两组术后6个月、2年ODI指数、VAS评分以及冠状位Cobb角均低于术前，矢状位Cobb角、腰椎前凸角、骶骨倾斜角、骨盆入射角高于术前，但术后3个月、2年OLIF术组冠状位Cobb角[（22.2±3.2）°，（22.2±3.2）°]显著高于TLIF组[（20.1±2.0）°（20.1±2.0）°，t=4.534、t=4.798，P<0.001]，术后3个月、2年OLIF组冠状位Cobb角[（3.2 ± 0.4）°、（3.5 ± 0.3）°]，显著低于TLIF组[（5.5 ± 1.0）°、（5.6 ± 0.8）°，t=16.265、t=20.595，P<0.001]，术后3个月、术后2年OLIF组腰椎前凸角[（47.2±3.2）°、（46.9±2.6）°]显著高于TLIF组[（39.2±3.2°、38.9±2.4°，t=14.602，t=18.498，P<0.001]，术后3个月、2年OLIF组骶骨倾斜角[（34.8±4.3）°、（34.4±4.0）°]显著高于TLIF组[（30.4±4.2）°、（30.0±3.9）°，t=5.964，t=6.494，P< 0.001]。

结论

TLIF术、OLIF术治疗DLS均能获得确切的近期疗效，OLIF术手术时间略长，但创伤更小，冠状位、矢状位矫正效果更好。

关键词: 斜外侧腰椎椎间融合术, 经椎间孔椎间融合术, 退行性腰椎侧凸
Objective

To investigate the difference between oblique lateral lumbar interbody fusion(OLIF) and transforaminal interbody fusion (TLIF) for the treatment of degenerative lumbar scoliosis (DLS).

Methods

A retrospective analysis of 134 patients with DLS admitted to our hospital from February 2017 to February 2019. According to different surgical methods, they were divided into OLIF operation group (64 cases) and TLIF operation group (70 cases), the two groups of patients were compared for operation related Indicators, complications, fusion rate were compared, and visual analog scale (VAS) and Oswestry disability index (ODI) were evaluated preoperatively, 6 months, and 2 years postoperatively. The coronal position, sagittal Cobb angle, lumbar lordosis angle, sacral tilt angle, pelvic incidence angle were calculated.

Results

The operation time of the OLIF group was (243 ± 39) min, which was significantly higher than that of the TLIF group (215±29) min, (t=3.432, P=0.001). The intraoperative blood loss in the OLIF group was (411± 34) ml, Significantly lower than the control group (653 ± 42) ml, (t=4.865, P<0.001); the ODI index, VAS score, and coronal Cobb angle of the two groups were lower than that of the operation 6 months after the operation and 2 years after the operation. The sagittal Cobb angle, lumbar lordosis angle, sacral inclination angle, and pelvic angle of incidence were higher than those before surgery, but the coronal Cobb angles in the OLIF surgery group were (22.2±3.2)° at 3 months and 2 years after surgery (22.2±3.2)°, significantly higher than (20.1±2.0)°, (20.1±2.0)°, (t=4.534, t=4.798, P<0.001) in the TLIF group, 3 months after operation, 2 years postoperatively, the coronal Cobb angles in the OLIF group were (3.2 ± 0.4)° and (3.5 ± 0.3)°, which were significantly lower than the (5.5 ± 1.0)° and (5.6 ± 0.8)° in the TLIF group, (t=16.265, t=20.595, P<0.001), the lumbar lordosis angles of the OLIF operation group were (47.2±3.2)° and (46.9±2.6)° at 3 months and 2 years after operation, which were significantly higher than those of TLIF (39.2±3.2)°, (38.9±2.4)°, (t=14.602, t=18.498, P<0.001) in the operation group, the sacral inclination angles of the OLIF operation group at 3 months and 2 years after the operation were respectively (34.8±4.3)° and (34.4±4.0)° were significantly higher than (30.4±4.2)° and (30.0±3.9)° in the TLIF group, (t=5.964, t=6.494, both P<0.001).

Conclusion

Both TLIF and OLIF can obtain definite short-term curative effects in the treatment of DLS. OLIF has a slightly longer operation time, but has less trauma and better coronal and sagittal correction effects.

Key words: Oblique lumbar interbody fusion, Transforminal lumbar interbody fusion, Degenerative lumbar scoliosis
表1 两组退行性腰椎侧凸患者一般资料比较
组别 例数 性别 LenkeSilva分型 年龄（岁） 融合节段数（个）
男/女 Ⅱ型/Ⅲ型
OLIF术组 64 28/36 52/12 65±6 2.7±0.5
TLIF术组 70 30/40 54/16 66±6 2.7±0.5
统计值   χ2=0.011 χ2=0.341 t=0.895 t=0.688
P值   0.917 0.559 0.0.373 0.439
组别 例数 BMI（kg/m2） 合并高血压 合并糖尿病 融合位置
L1~4/L2~5/L2~4/L3~5/L2~3/L3~4/L4~5
OLIF术组 64 22.8±2.0 10 7 6/12/18/8/9/7/4
TLIF术组 70 22.9±2.1 12 9 8/15/20/13/6/5/3
统计值   t=0.364 χ2=0.056 χ2=0.117 χ2=0.103
P值   0.717 0.813 0.732 0.858
表2 两组退行性腰椎侧凸患者手术相关指标比较（±s）
组别 例数 手术时间（min） 术中出血（ml） 住院天数（d）
OLIF术组 64 243±39 411±34 7.0±2.1
TLIF术组 70 215±29 653±42 7.4±2.1
t值   3.432 4.865 0.905
P值   0.001 <0.001 0.367
表3 两组退行性腰椎侧凸患者术后椎间融合率、并发症总发生率比较[例（%）]
组别 例数 椎间融合率 并发症
交感神经损伤症状 动脉损伤 慢性腰背痛 切口感染 总发生率
OLIF术组 64 62（96.88） 2 2 4 0 8（12.50）
TLIF术组 70 66（94.29） 0 0 8 2 10（14.29）
χ2值   0.524         0.092
P值   0.469         0.762
表4 两组退行性腰椎侧凸患者功能指标及影像学指标比较（±s）
组别 例数 ODI指数（%） F值 P值
术前 术后3个月 术后2年
OLIF术组 64 65.34±6.05 30.56±4.18a 21.66±3.15ab 1598.471 <0.001
TLIF术组 70 66.14±7.56 31.07±4.56a 22.34±3.53ab 1248.332 <0.001
t值   0.672 0.672 1.172    
P值   0.503 0.502 0.243    
组别 例数 矢状位Cobb角（°） F值 P值
术前 术后3个月 术后2年
OLIF术组 64 9.48±1.23 22.21±3.22a 22.19±3.20a 679.490 <0.001
TLIF术组 70 9.39±1.30 20.12±2.03a 20.08±2.01a 913.021 <0.001
t值   0.411 4.534 4.798    
P值   0.682 <0.001 <0.001    
组别 例数 腰椎前凸角（°） F值 P值
术前 术后3个月 术后2年
OLIF术组 64 29.48±±4.24 47.22±3.22a 46.86±2.63a 559.822 <0.001
TLIF术组 70 28.92±4.31 39.18±3.15a 38.87±2.37a 191.693 <0.001
t值   0.757 14.602 18.498    
P值   0.450 <0.001 <0.001    
组别 例数 骨盆入射角（°） F值 P值
术前 术后3个月 术后2年
OLIF术组 64 46.34±4.88 49.23±5.20a 49.04±4.73a 9.760 <0.001
TLIF术组 70 46.18±4.94 48.87±4.15a 48.77±4.37a 8.041 <0.001
t值   0.188 0.445 0.343    
P值   0.851 0.657 0.732    
组别 例数 VAS评分 F值 P值
术前 术后3个月 术后2年
OLIF术组 64 6.27±0.98 2.29±0.33a 1.78±0.17ab 1056.581 <0.001
TLIF术组 70 6.30±0.95 2.35±0.30a 1.84±0.20ab 1200.521 <0.001
t值   0.180 1.103 1.862    
P值   0.858 0.272 0.065    
组别 例数 冠状位Cobb角（°） F值 P值
术前 术后3个月 术后2年
OLIF术组 64 14.54±2.34 3.21±0.45a 3.46±0.30a 1372.383 <0.001
TLIF术组 70 14.58±2.54 5.48±1.03a 5.60±0.78a 704.511 <0.001
t值   0.095 16.265 20.595    
P值   0.925 <0.001 <0.001    
组别 例数 骶骨倾斜角（°） F值 P值
术前 术后3个月 术后2年
OLIF术组 64 24.53±2.34 34.76±4.30a 34.43±4.05a 160.741 <0.001
TLIF术组 70 24.52±2.50 30.40±4.16a 29.98±3.88a 58.531 <0.001
t值   0.024 5.964 6.494    
P值   0.981 <0.001 <0.001    
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