O型臂导航下单一体位OLIF联合后路固定与后路减压内固定治疗腰椎Ⅱ度滑脱症疗效对比

doi:10.3877/cma.j.issn.2096-0263.2026.04.002

目的

对比O型臂导航下斜外侧椎间融合术（OLIF）单一体位联合后路经皮固定与后路减压融合内固定术治疗腰椎Ⅱ度滑脱症的疗效。

方法

回顾性分析2019年1月至2022年12月我院收治的83例腰椎Ⅱ度滑脱症患者，男53例，女30例，平均年龄（66.49±7.36）岁。其中A组（n=36）接受O型臂导航引导下单一体位OLIF联合后路经皮固定，B组（n=47）行后路减压融合内固定术。对比两组手术时间、术中出血量、疼痛视觉模拟（VAS）评分、ODI评分、下地时间、住院时间、腰椎间隙高度、滑脱率、腰椎前凸角、融合情况及并发症发生率。

结果

两组患者均顺利完成手术，平均随访时间（23.13±4.55）月；A组与B组患者平均手术时间为（138.65±22.38）min、（121.41±21.19）min，术中平均出血量为（103.61±27.36）ml、（369.48±54.18）ml，平均下地时间为（2.19±0.79）天、（2.53±0.92）天，平均住院时间为（5.97±0.72）天、（6.15±0.67）天。A组术中平均出血量低于B组（P<0.01），而平均手术时间、下地时间及住院时间两组间差异无统计学意义（均P>0.05）。两组术后1周、6月及末次随访腰痛及腿痛VAS进行重复测量设计的方差分析显示两组间差异有统计学意义，组别与时间点间存在交互作用，术后1周腰痛及腿痛VAS比较，两组差别有统计学意义（P<0.05）。两组患者不同时间点的ODI比较，差异均无统计学意义（均P>0.05）。两组术后6月及末次随访时的椎间隙高度、滑脱率、腰椎前凸角进行重复测量设计的方差分析显示两组间差异有统计学意义，组别与时间点间存在交互作用，两组患者术后6月及末次随访时的椎间隙高度、滑脱率、腰椎前凸角比较，两组差异均具有统计学意义（均P<0.05）。A组患者在末次随访时97.22%达到I级融合，2.78%的患者达到Ⅱ级融合，B组患者在末次随访时82.98%达到I级融合，17.02%的患者达到Ⅱ级融合，两组比较，差异具有统计学意义（P<0.05）。B组并发症发生率为25.53%（12/47），高于A组的11.11%（4/36），但差异无统计学意义（P>0.05）。

结论

与后路减压内固定相比，O型臂导航引导下单一体位OLIF联合后路固定在出血量、早期疼痛缓解、滑脱复位、腰椎节段力线恢复及融合率方面更具优势，该术式可作为腰椎Ⅱ度滑脱症的微创治疗选择。

关键词: O型臂导航, 单一体位, OLIF, 腰椎后路, 腰椎滑脱

Objective

To compare the outcomes of O-arm navigation-guided single-position oblique lateral interbody fusion (OLIF) with posterior percutaneous fixation versus posterior decompression and fusion with internal fixation in treating grade Ⅱ lumbar spondylolisthesis.

Methods

We retrospectively reviewed 83 consecutive patients (53 men, 30 women; mean age, 66.49±7.36 years) with grade II lumbar spondylolisthesis treated between January 2019 and December 2022. Group A (n=36) underwent single-position OLIF with posterior percutaneous fixation under O-arm navigation, while Group B (n=47) received posterior decompression with instrumented fusion. Comparative parameters included operative duration, intraoperative blood loss, visual analog scale (VAS) scores, Oswestry Disability Index (ODI), time to ambulation, hospitalization length, intervertebral disc space height, slip rate, lumbar lordosis angle, fusion, and complication rates.

Result

All patients successfully completed the operation, with an average follow-up of (23.13±4.55) months. In group A, the average operation time was (138.65±22.38) min, the average intraoperative blood loss was (103.61±27.36) ml, the average time to ambulation was (2.19±0.79) days, and the hospital stay was (5.97±0.72) days. In group B, the average operation time was (121.41±21.19) min, the average intraoperative blood loss was (369.48±54.18) ml, the average time to ambulation was (2.53±0.92) days, and the hospital stay was (6.15±0.67) days. The average intraoperative blood in Group A was significantly lower than that in the control group (P<0.01), while there was no statistically significant difference in the average operation time, time to ambulation and hospital stay between the two groups (all P>0.05). Repeated measures variance analysis of VAS for low back and leg pain at 1 week, 6 months and the final follow-up showed that there was a significant difference between the two groups. And there was an interaction between the group and the time point. The VAS for low back and leg pain at 1 week were significant difference between the two groups (P<0.05). No significant difference of the ODI in the two groups at different time points (all P>0.05). Repeated measures variance analysis of intervertebral space, slip rate and lumbar lordosis angle at 6 months and the final follow-up showed that there was a significant difference between the two groups. There was an interaction between the groups and time points. In terms of intervertebral disc space height, slip rate and lumbar lordosis angle, there were significant differences at 6 months and the final follow-up (all P<0.05). In terms of fusion, 97.22% of group A reached grade I and 2.78% of patients reached grade Ⅱ at the final follow-up, while 82.98% of group B reached grade I and 17.02% reached grade Ⅱ, the difference was statistically significant (P<0.05). The incidence of complications in group B was 25.53% (12/47), which was higher than that in group A (11.11%). However, the difference was not statistically significant (P>0.05).

Conclusion

O-arm navigation-guided single-position OLIF with posterior fixation offers distinct advantages over posterior approaches in blood loss, early pain relief, slip reduction, lumbar segmental alignment restoration, and fusion rate. This minimally invasive strategy represents a viable alternative for grade Ⅱ lumbar spondylolisthesis management.

Key words: O-arm navigation, Single-position surgery, Oblique lateral interbody fusion, Posterior lumbar fusion, Lumbar spondylolisthesis

表1 两组腰椎滑脱患者一般情况比较

组别	例数	年龄（岁，±s）	男/女（例）	骨密度（±s）	BMI（kg/m²，±s）	症状持续时间（月，±s）	病变节段（例）			滑脱类型（例）
组别	例数	年龄（岁，±s）	男/女（例）	骨密度（±s）	BMI（kg/m²，±s）	症状持续时间（月，±s）	L₂	L₃	L₄	真性	假性
A组	36	66.14±7.41	23/13	-0.62（-0.86，-0.38）	26.26±2.71	6.55±0.91	7	11	18	24	12
B组	47	66.67±6.18	30/17	-0.35（-0.63，-0.07）	27.14±4.23	7.15±0.85	9	15	23	28	19
t/χ²值		-0.667	0.000	-1.543	-0.234	-1.524	2.270			0.385
P值		0.524	0.993	0.161	0.821	0.166	0.321			0.535

表1 两组腰椎滑脱患者一般情况比较

组别	例数	年龄（岁，±s）	男/女（例）	骨密度（±s）	BMI（kg/m²，±s）	症状持续时间（月，±s）	病变节段（例）			滑脱类型（例）
组别	例数	年龄（岁，±s）	男/女（例）	骨密度（±s）	BMI（kg/m²，±s）	症状持续时间（月，±s）	L₂	L₃	L₄	真性	假性
A组	36	66.14±7.41	23/13	-0.62（-0.86，-0.38）	26.26±2.71	6.55±0.91	7	11	18	24	12
B组	47	66.67±6.18	30/17	-0.35（-0.63，-0.07）	27.14±4.23	7.15±0.85	9	15	23	28	19
t/χ²值		-0.667	0.000	-1.543	-0.234	-1.524	2.270			0.385
P值		0.524	0.993	0.161	0.821	0.166	0.321			0.535

表2 两组腰椎滑脱患者术前滑脱率、椎间隙高度、腰椎前凸角比较

组别	例数	术前滑脱率（%，±s）	术前椎间隙高度（mm，±s）	术前腰椎前凸角（°，±s）
A组	36	34.35±6.87	6.05±1.42	36.18±2.88
B组	47	35.60±5.95	6.11±1.21	35.91±3.07
t/χ²值		0.518	0.011	0.041
P值		0.492	0.921	0.844

表2 两组腰椎滑脱患者术前滑脱率、椎间隙高度、腰椎前凸角比较

组别	例数	术前滑脱率（%，±s）	术前椎间隙高度（mm，±s）	术前腰椎前凸角（°，±s）
A组	36	34.35±6.87	6.05±1.42	36.18±2.88
B组	47	35.60±5.95	6.11±1.21	35.91±3.07
t/χ²值		0.518	0.011	0.041
P值		0.492	0.921	0.844

表3 两组腰椎滑脱患者手术前后腰痛VAS评分比较（分，

±s）

组别	例数	术前	术后1周	术后6月	末次随访	F值	P值
A组	36	7.39±1.21	3.89±1.12^a	2.33±0.87^ab	1.78±0.61^abc	993.266	<0.001
B组	47	7.28±1.34	4.47±0.97^a	2.41±0.75^ab	1.83±0.55^abc	3.569	0.026
F值		0.144	6.003	0.194	0.164
P值		0.673	0.022	0.585	0.693

表3 两组腰椎滑脱患者手术前后腰痛VAS评分比较（分，

±s）

组别	例数	术前	术后1周	术后6月	末次随访	F值	P值
A组	36	7.39±1.21	3.89±1.12^a	2.33±0.87^ab	1.78±0.61^abc	993.266	<0.001
B组	47	7.28±1.34	4.47±0.97^a	2.41±0.75^ab	1.83±0.55^abc	3.569	0.026
F值		0.144	6.003	0.194	0.164
P值		0.673	0.022	0.585	0.693

表4 两组腰椎滑脱患者手术前后腿痛VAS评分比较（分，

±s）

组别	例数	术前	术后1周	术后6月	末次随访	F值	P值
A组	36	6.56±1.24	3.02±0.35^a	1.34±0.45^ab	0.17±0.10^abc	120.297	<0.001
B组	47	6.50±1.35	3.78±0.38^a	1.45±0.31^ab	0.23±0.16^abc	2.944	0.038
F值		0.006	12.964	0.270	0.608
P值		0.939	0.011	0.617	0.455

表4 两组腰椎滑脱患者手术前后腿痛VAS评分比较（分，

±s）

组别	例数	术前	术后1周	术后6月	末次随访	F值	P值
A组	36	6.56±1.24	3.02±0.35^a	1.34±0.45^ab	0.17±0.10^abc	120.297	<0.001
B组	47	6.50±1.35	3.78±0.38^a	1.45±0.31^ab	0.23±0.16^abc	2.944	0.038
F值		0.006	12.964	0.270	0.608
P值		0.939	0.011	0.617	0.455

表5 两组腰椎滑脱患者手术前后ODI评分比较（%，

±s）

组别	例数	术前	术后6月	术后12月	末次随访	F值	P值
A组	36	70.61±1.82	20.47±2.35^a	14.14±1.98^ab	11.58±1.36^abc	891.392	<0.001
B组	47	71.05±1.90	23.51±2.50^a	16.40±2.12^ab	13.25±1.78^abc	891.392	<0.001
F值		0.365
P值		0.562

表5 两组腰椎滑脱患者手术前后ODI评分比较（%，

±s）

组别	例数	术前	术后6月	术后12月	末次随访	F值	P值
A组	36	70.61±1.82	20.47±2.35^a	14.14±1.98^ab	11.58±1.36^abc	891.392	<0.001
B组	47	71.05±1.90	23.51±2.50^a	16.40±2.12^ab	13.25±1.78^abc	891.392	<0.001
F值		0.365
P值		0.562

表6 两组腰椎滑脱患者手术前后椎间隙高度比较（mm，

±s）

组别	例数	术前	术后6月	末次随访	F值	P值
A组	36	6.05±1.42	11.43±0.65^a	11.08±0.68^a	343.322	<0.001
B组	47	6.11±1.21	10.09±0.72^a	9.96±0.75^a	7.004	0.005
F值		0.011	19.084	12.239
P值		0.921	0.002	0.008

表6 两组腰椎滑脱患者手术前后椎间隙高度比较（mm，

±s）

组别	例数	术前	术后6月	末次随访	F值	P值
A组	36	6.05±1.42	11.43±0.65^a	11.08±0.68^a	343.322	<0.001
B组	47	6.11±1.21	10.09±0.72^a	9.96±0.75^a	7.004	0.005
F值		0.011	19.084	12.239
P值		0.921	0.002	0.008

表7 两组腰椎滑脱患者手术前后滑脱率比较（%，

±s）

组别	例数	术前	术后6月	末次随访	F值	P值
A组	36	34.35±6.87	4.42±2.18^a	4.38±1.86^a	719.064	<0.001
B组	47	35.60±5.95	6.97±2.73^a	7.05±2.25^a	6.655	0.034
F值		0.518	5.808	8.352
P值		0.492	0.043	0.020

表7 两组腰椎滑脱患者手术前后滑脱率比较（%，

±s）

组别	例数	术前	术后6月	末次随访	F值	P值
A组	36	34.35±6.87	4.42±2.18^a	4.38±1.86^a	719.064	<0.001
B组	47	35.60±5.95	6.97±2.73^a	7.05±2.25^a	6.655	0.034
F值		0.518	5.808	8.352
P值		0.492	0.043	0.020

表8 两组腰椎滑脱患者手术前后腰椎前凸角比较（°，

±s）

组别	例数	术前	术后6月	末次随访	F值	P值
A组	36	36.18±2.88	42.06±1.76^a	41.87±1.07^a	164.859	<0.001
B组	47	35.91±3.07	39.19±2.18^a	38.81±1.92^a	15.211	0.003
F值		0.041	10.493	19.381
P值		0.844	0.012	0.002

表8 两组腰椎滑脱患者手术前后腰椎前凸角比较（°，

±s）

组别	例数	术前	术后6月	末次随访	F值	P值
A组	36	36.18±2.88	42.06±1.76^a	41.87±1.07^a	164.859	<0.001
B组	47	35.91±3.07	39.19±2.18^a	38.81±1.92^a	15.211	0.003
F值		0.041	10.493	19.381
P值		0.844	0.012	0.002

图1~15　患者，女性，66岁，L₄双侧椎弓根峡部裂并椎体滑脱症（Ⅱ度），行O型臂导航下单一体位OLIF联合后路L_4-5经皮螺钉固定。图1~6　术前影像学示：L₄双侧椎弓根峡部裂并椎体Ⅱ度滑脱，L_4-5椎管狭窄；图7~8　术后3 dX线示：L₄椎体滑脱复位良好，内固定在位；图9~11　术后3 dCT示：L_4-5椎弓根螺钉位置良好，融合器在位，上下骨性终板保持完整；图12~15　术后18月影像学示：内固定在位可靠，L_4-5椎间已融合

图16~25　患者，女性，60岁，L₄双侧椎弓根峡部裂并椎体滑脱症（Ⅱ度），行腰椎后路L_4-5减压融合内固定。图16~19　术前影像学示：L₄双侧椎弓根峡部裂并椎体Ⅱ度滑脱，L_4-5椎管狭窄；图20~21　术后3 dX线示：L₄椎体滑脱复位良好，内固定在位；图22~23　术后3 dCT示：L_4-5椎弓根螺钉位置良好，融合器在位，减压彻底；图24~25　术后30月影像学示：L_4-5内固定在位可靠

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Comparative analysis of single-position O-Arm navigation-guided OLIF with posterior fixation versus posterior decompression and fusion for grade Ⅱ lumbar spondylolisthesis

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Comparative analysis of single-position O-Arm navigation-guided OLIF with posterior fixation versus posterior decompression and fusion for grade Ⅱ lumbar spondylolisthesis