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比较退行性腰椎滑脱症的临床结果和脊柱骨盆矢状平衡:微创斜侧腰椎间融合术(OLIF)与经椎间孔腰椎间融合术(TLIF)。

Comparison of clinical outcomes and spino-pelvic sagittal balance in degenerative lumbar spondylolisthesis: Minimally invasive oblique lumbar interbody fusion (OLIF) versus transforaminal lumbar interbody fusion (TLIF).

机构信息

Department of Orthopaedics, The First Affiliated Hospital of Soochow University, 188 Shizi Street, Suzhou, Jiangsu Province 215006, China.

出版信息

Medicine (Baltimore). 2021 Jan 22;100(3):e23783. doi: 10.1097/MD.0000000000023783.

Abstract

Spino-pelvic sagittal parameters are closely related to the lumbar degenerative diseases. The present study aims to compare clinical results and spino-pelvic sagittal balance treated with oblique lumbar interbody fusion (OLIF) and transforaminal lumbar interbody fusion (TLIF) in patients with degenerative lumbar spondylolisthesis at single segment.We retrospectively reviewed and compared 28 patients who underwent OLIF (OLIF group) and 35 who underwent TLIF (TLIF group). Radiological results were evaluated with disc height (DH), foraminal height (FH), fused segment lordosis (FSL), lumbar lordosis (LL), pelvic tilt (PT), pelvic incidence (PI), and sacral slope (SS). Clinical results were evaluated with the Oswestry Disability Index (ODI) and VAS for back and leg pain.The OLIF group showed higher improvement of DH and FH than the TLIF group at all time points after surgery (P < .05). No significant differences were found in PT, PI, and SS between the 2 groups (P > .05). Significant restoration of spino-pelvic sagittal balance was observed in the 2 groups after surgery. Significant differences in postoperative lumbar lordosis and fused segment lordosis were found between the 2 groups (P < .05). Significant difference in the improvement of symptoms was observed between the 2 groups. The OLIF group had lower VAS scores for back pain and ODI compared after surgery (P < .05).It can be concluded that there are exactly differences in improvement of radiographic parameters between 2 approaches, which confirmed that OLIF is better in restoring spinal alignment. Besides, due to the unique minimally invasive approach, OLIF did exhibit a greater advantage in early recovery after surgery.

摘要

骨盆矢状面参数与腰椎退行性疾病密切相关。本研究旨在比较单节段退变性腰椎滑脱患者采用斜侧腰椎间融合术(OLIF)和经椎间孔腰椎间融合术(TLIF)治疗的临床结果和脊柱骨盆矢状面平衡。

我们回顾性比较了 28 例接受 OLIF(OLIF 组)和 35 例接受 TLIF(TLIF 组)的患者。影像学结果通过椎间盘高度(DH)、椎间孔高度(FH)、融合节段前凸角(FSL)、腰椎前凸角(LL)、骨盆倾斜角(PT)、骨盆入射角(PI)和骶骨倾斜角(SS)进行评估。临床结果采用 Oswestry 功能障碍指数(ODI)和腰痛、腿痛视觉模拟评分(VAS)进行评估。

OLIF 组术后各时间点 DH 和 FH 的改善均高于 TLIF 组(P<.05)。两组间 PT、PI 和 SS 无显著差异(P>.05)。术后两组脊柱骨盆矢状面平衡均得到显著恢复。术后两组腰椎前凸角和融合节段前凸角存在显著差异(P<.05)。两组间症状改善存在显著差异。OLIF 组术后腰痛 VAS 评分和 ODI 低于 TLIF 组(P<.05)。

综上所述,两种方法在影像学参数的改善方面存在差异,证实 OLIF 在恢复脊柱排列方面更有优势。此外,由于其独特的微创方法,OLIF 在术后早期恢复方面具有更大的优势。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a887/7837863/e940e511033b/medi-100-e23783-g001.jpg

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