脊柱内镜辅助斜外侧椎间融合术与经椎间孔腰椎椎体间融合术治疗腰椎不稳伴腰椎间盘突出症的疗效观察

Clinical observation of endoscope assisted oblique lateral interbody fusion and transforaminal lumbar interbody fusion in treatment of lumbar instability with lumbar disc herniation

摘要:

目的 探究脊柱内镜辅助斜外侧椎间融合术（OLIF）与经椎间孔腰椎椎体间融合术（TLIF）治疗腰椎不稳伴腰椎间盘突出症的疗效。方法 选取2017年9月－2019年8月该院诊治的腰椎不稳伴腰椎间盘突出症的患者87例，根据不同手术方式分为OLIF组与TLIF组，OLIF组44例，TLIF组43例。OLIF组患者选用脊柱内镜辅助OLIF方式进行手术，TLIF组患者选用脊柱内镜辅助TLIF方式进行手术。比较两组患者术前、术后和末次随访的视觉模拟评分（VAS）、Oswestry功能障碍指数（ODI）、影像学参数（腰椎矢状位Cobb角、腰椎冠状位Cobb角以及顶椎中心偏移距离），比较两组患者初次下床行走时间、住院时间、融合率、塌陷率和并发症发生率，评估两组患者治疗效果。结果 时间上，术前、术后和末次随访时VAS和ODI比较，差异均有统计学意义（P < 0.05）。组别上，术前、术后和末次随访时OLIF组与TLIF组VAS和ODI比较，差异均无统计学意义（P > 0.05）；OLIF组和TLIF组腰椎矢状位Cobb角大于手术前，腰椎冠状位Cobb角以及顶椎中心偏移距离小于术前，差异均有统计学意义（P < 0.05），且OLIF组3种影像学参数恢复情况均优于TLIF组，差异有统计学意义（P < 0.05）；OLIF组术后首次下床时间和住院时间明显短于TLIF组，差异有统计学意义（P < 0.05）；OLIF组与TLIF组椎间融合器融合率比较，差异无统计学意义（P > 0.05）。OLIF组椎间融合器塌陷率低于TLIF组，差异有统计学意义（P < 0.05）。结论 脊柱内镜辅助下，OLIF比TLIF治疗腰椎不稳伴腰椎间盘突出症的疗效更好，患者恢复更快，值得临床推广应用。

Abstract:

Objective To explore the efficacy of oblique lateral interbody fusion (OLIF) and transforaminal lumbar interbody fusion (TLIF) in treatment of lumbar instability with lumbar disc herniation.Methods 87 patients with lumbar instability and lumbar disc herniation were selected from September 2017 to August 2019. They were divided into OLIF group and TLIF group. There were 44 cases in OLIF group and 43 cases in TLIF group. The patients in OLIF group were operated by spinal endoscopy assisted OLIF, and the patients in TLIF group were operated by spinal endoscopy assisted TLIF. The visual analogue scale (VAS), Oswestry dysfunction index (ODI), imaging parameters (lumbar sagittal Cobb angle, lumbar coronal Cobb angle and apical vertebral center offset distance), initial ambulation time and hospital stay, fusion rate, collapse rate and complication rate of the two groups were compared before and after the last follow-up.Results In terms of time, there were significant differences in VAS score and ODI before operation, after operation and at the last return visit (P < 0.05). There was no significant difference in VAS score and ODI between OLIF group and TLIF group before operation, after operation and at the last return visit (P > 0.05); The Cobb angle of lumbar sagittal position in OLIF group and TLIF group were greater than those before operation, and the Cobb angle of lumbar coronal position and the deviation distance of parietal vertebra center were less than those before operation (P < 0.05). The recovery of three imaging parameters in OLIF group was better than that in TLIF group (P < 0.05); The first ambulation time and hospital stay in OLIF group were significantly shorter than those in TLIF group (P < 0.05); The fusion rate of interbody fusion cage was compared between OLIF group and TLIF group; There was no significant difference (P > 0.05). The collapse rate of interbody fusion cage in OLIF group was significantly lower than that in TLIF group (P < 0.05).Conclusion Assisted by spinal endoscopy, OLIF is more effective than TLIF in treatment of lumbar instability with lumbar disc herniation, and patients can obtain better correction, it is worthy of clinical promotion and application.