Chen Y L, Zhu Z H, Wang Y K, Fan S W, Fang X Q, Wan S L, Zhang J F, Zhao X, Zhao F D
Department of Orthopedics, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou 310016, China.
Zhonghua Yi Xue Za Zhi. 2018 Jul 3;98(25):1990-1995. doi: 10.3760/cma.j.issn.0376-2491.2018.25.005.
To compare the operation time, estimated blood loss, clinical outcome and correction of lumbar lordosis between oblique lateral interbody fusion (OLIF) and transforaminal lumbar interbody fusion (TLIF) in patients with degenerative lumbar diseases. Seventy-three patients who underwent OLIF or TLIF surgery from January 2016 to December 2017 in Sir Run Run Shaw Hospital Zhejiang University were analyzed in this retrospective case-control study. The patients included 31 males and 42 females, with a mean age of 65.8 years (range, 36-88 years). Of the patients, there were 9 cases of calcified disc herniation, 34 cases of spinal stenosis, 17 cases of degenerative spondylolithesis, 12 cases of degenerative scoliosis and 1 case of isthmic spondylolithesis. According to the type of surgery, patients were divided into OLIF group (34 cases) and TLIF group (39 cases). The operation time, estimated blood loss and transfusion were recorded, pre-and post-operative visual analogue scale (VAS) for back pain and Oswestry Disability Index (ODI) were evaluated, and pre- and post-operative lumbar lordosis (LL) and fused segment lordosis (FSL) were measured. Student test were used in comparison between groups. Ten (29.4%) patients in OLIF group and all 39 (100%) patients in TLIF group were supplemented with posterior instrumentation (χ(2)=41.013, <0.05). The average operation time and estimated blood loss was significantly lower in OLIF group than in those in TLIF group[(163±68) vs (233±79) min, (116±148) vs (434±201) ml, =4.019, 6.964, both <0.05]. There was no significant differences in decreases value in VAS and ODI after surgery between the two groups (=1.716, 0.522, both >0.05). The correction of LL was 4.0°±10.0° in the OLIF group and 4.2°±6.1° in the TLIF group; the correction of FSL was 4.1°±7.0° in the OLIF group and 5.2°±4.6° in the TLIF group, with no significant differences between the two groups too (=0.139, 0.805, both >0.05). The correction of LL was significantly higher in OLIF group with posterior instrumentation than that in TLIF group (9.9°±11.1° vs 4.2°±6.1°, =2.180, <0.05). Both OLIF and TLIF can restore LL to some extent, but OLIF has obvious advantages in the operation time and blood loss during surgery. When supplemented with posterior instrumentation, OLIF can achieve better correction of LL than TLIF.
比较斜外侧椎间融合术（OLIF）与经椎间孔腰椎椎间融合术（TLIF）治疗退变性腰椎疾病患者的手术时间、估计失血量、临床疗效及腰椎前凸的矫正情况。在这项回顾性病例对照研究中，分析了2016年1月至2017年12月在浙江大学医学院附属邵逸夫医院接受OLIF或TLIF手术的73例患者。患者包括31例男性和42例女性，平均年龄65.8岁（范围36 - 88岁）。其中，钙化性椎间盘突出9例，腰椎管狭窄34例，退变性椎体滑脱17例，退变性脊柱侧凸12例，峡部裂性椎体滑脱1例。根据手术类型，患者分为OLIF组（34例）和TLIF组（39例）。记录手术时间、估计失血量和输血量，评估术前和术后的背痛视觉模拟评分（VAS）和Oswestry功能障碍指数（ODI），测量术前和术后的腰椎前凸（LL）和融合节段前凸（FSL）。采用Student检验进行组间比较。OLIF组10例（29.4%）患者和TLIF组所有39例（100%）患者均行后路内固定（χ(2)=41.013，<0.05）。OLIF组的平均手术时间和估计失血量显著低于TLIF组[（163±68） vs （233±79）分钟，（116±148） vs （434±201）毫升，=4.019，6.964，均<0.05]。两组术后VAS和ODI的降低值无显著差异（=1.716，0.522，均>0.05）。OLIF组LL的矫正角度为4.0°±10.0°，TLIF组为4.2°±6.1°；OLIF组FSL的矫正角度为4.1°±7.0°，TLIF组为5.2°±4.6°，两组间也无显著差异（=0.139，0.805，均>0.05）。OLIF组行后路内固定时LL的矫正显著高于TLIF组（9.9°±11.1° vs 4.2°±6.1°，=2.180，<0.05）。OLIF和TLIF均可在一定程度上恢复LL，但OLIF在手术时间和术中失血量方面具有明显优势。当行后路内固定时，OLIF对LL的矫正效果优于TLIF。
