斜外侧腰椎间融合术联合经皮椎弓根螺钉内 固定术治疗腰椎退变性疾病的效果

Effect of OLIF Combined with Posterior Percutaneous Pedicle Screw Internal Fixation in the Treatment of Degenerative Lumbar Diseases

摘要:

〔摘 要〕 目的：探讨斜外侧腰椎间融合术（OLIF）联合经皮椎弓根螺钉内固定术（PF）治疗腰椎退变性疾病的临床疗 效。 方法：选取 2018 年 6 月至 2022 年 5 月赣州市人民医院收治的 80 例腰椎退变性患者，随机分为经椎间孔腰椎间融合术 （TLIF）组和 OLIF–PF 组，各 40 例。比较两组患者手术相关指标、腰痛程度、功能障碍程度、骨融合情况、并发症发生 情况。 结果：OLIF–PF 组患者手术出血量少于 TLIF 组，手术时间、放射线暴露时间短于 TLIF 组，差异具有统计学意义 （P ＜ 0.05）。术后 1 周、术后 1 年，OLIF–PF 患者视觉模拟评分法（VAS）、Oswestry 功能障碍指数问卷表（ODI）评分 低于 TLIF 组，差异具有统计学意义（P ＜ 0.05）。术后 6 个月，两组患者经计算机断层扫描（CT）检查均显示骨融合良好。 OLIF–PF 组无手术并发症发生。TLIF 组 2 例患者出现术侧拇趾背伸肌力 4 级，考虑神经根牵拉所致，术后 2 周肌力恢复至 5 级；2 例患者出现腰痛部疼痛，给予口服塞来昔布等止痛药物后好转。 结论：OLIF–PF 治疗腰椎退变性疾病手术效果良好， 与 TLIF 相比具有手术创伤小及并发症少等优点。

Abstract:

〔Abstract〕 Objective To evaluate the clinical effect of oblique lumbar interbody fusion (OLIF) combined with posterior percutaneous pedicle screw internal fixation (PF) in the treatment of degenerative lumbar diseases. Methods A total of 80 patients with degenerative lumbar diseases admitted to Ganzhou People's Hospital from June 2018 to May 2022 were randomly divided into transforaminal lumbar interbody fusion (TLIF) group and OLIF-PF group, with 40 patients in each group. The indexes related to surgery, the degree of low back pain, the degree of dysfunction, the situation of bone fusion and the occurrence of complications were compared between the two groups. Results The operative blood loss in OLIF-PF group was less than that in TLIF group, and the operative time and radiation exposure time were shorter than those in TLIF group, with statistical significance (P < 0.05). At 1 week and 1 year after surgery, the visual analogue scales (VAS) and Oswestry dability index (ODI) scores of OLIF-PF patients were lower than those of TLIF group, and the differences were statistically significant (P < 0.05). Computer tomography (CT) examination showed good bone fusion 6 months after surgery in both groups. No surgical complications occurred in the OLIF-PF group. In the TLIF group, two patients had grade 4 muscle strength at operative great toe dorso-extension. Considering that it was caused by nerve root pulling, muscle strength recovered to grade 5 2 weeks after surgery. Two patients had low back pain and partial pain, which improved after oral administration of analgesic drugs such as celecoxib. Conclusion OLIF-PF has good surgical effect in the treatment of degenerative lumbar diseases, and has the advantages of less surgical trauma and fewer complications than TLIF. [Keywords] Degenerative lumbar; Oblique lumbar interbody fusion; Posterior percutaneous pedicle screw internal fixation; Transforaminal lumbar interbody fusion.