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中华老年骨科与康复电子杂志[ISSN:1674-3911/CN:11-9292/R]

卷:

期数:

2022年02期

页码:

80-90

栏目:

脊柱专题

出版日期:

2022-04-05

文章信息/Info

Title:

Comparative study of oblique lateral approach and posterior fusion in the treatment of grade Ⅰ-Ⅱ lumbar spondylolisthesis

作者:

曾忠友1; 张建乔1; 宋永兴1; 俞伟1; 范顺武2; 方向前2; 裴斐1; 宋国浩1; 范时洋1

314000 嘉兴，武警部队骨科中心 武警海警总队医院骨二科1；310016 杭州，浙江大学医学院附属邵逸夫医院骨科2

Author(s):

Zeng Zhongyou1;  Zhang Jianqiao1;  Song Yongxing1;  Yu Wei1;  Fan Shunwu2;  Fang Xiangqian2;  Pei Fei1;  Song Guohao1;  Fan Shiyang1.

1The Second Deptment of Orthopaedics, Hospital of Coast Guard General Corps of Armed Police Forces, Jiaxing 314000, China; 2Department of Orthopaedics, Sir Run Run Shaw Hospital of Medical College of Zhejiang University, Hangzhou 310016, China

关键词:

腰椎;  脊椎滑脱;  内固定;  脊柱融合术

Keywords:

Lumbar;  Spondylolisthesis;  Internal fixation;  Interbody fusion

DOI:

10.3877/cma.j.issn.2096-0263.2022.02.003

文献标志码:

A

摘要:

目的 比较斜外侧椎间融合联合后方肌间隙入路通道下椎弓根螺钉固定和后方肌间隙入路通道下椎弓根螺钉复位固定并椎间融合治疗Ⅰ～Ⅱ度腰椎滑脱症的优、缺点。方法 前瞻性收集2016年6月至2018年6月收治且符合纳入和排除标准的Ⅰ～Ⅱ度腰椎滑脱症115例患者，其中男33例，女82例；年龄41～72岁，平均（57.3±7.1）岁。采用后方肌间隙入路通道下椎弓根螺钉复位固定并椎间融合器植骨治疗56例（后路融合组），斜外侧椎间融合联合后方肌间隙入路通道下椎弓根螺钉固定治疗59例（斜外侧融合组）。记录并对比两组病例的手术时间、术中出血量、影像结果、临床结果和并发症情况。结果 两组病例均获得12～48个月，平均（27.0±3.4）个月的随访。与后路融合组对比，斜外侧融合组操作时间短，出血少，且差异均有统计学意义（P＜0.05）。两组病例术中、术后均未出现神经损伤或原有神经症状加重现象；术后切口皮肤无坏死，切口无感染。72 h腰部切口VAS评分斜外侧融合组[（1.10±0.08）分]低于后路复位融合组[（1.51±0.15）分，P＜0.05]。经重复测量设计的方差分析，后路融合组和斜外侧融合组术后和末次随访时的腰椎前凸角[术后（49±8）°，（53±6）°；末次随访（47±8）°，（51±9）°] 、滑脱率[术后（10.8±3.4）%，（3.6±1.3）%；末次随访（11.2±3.5）%，、（3.9±1.4）%]差异有统计学意义（P＜0.05）；两组间滑脱角［术后（8±2）°、（9±2）°；末次随访时（8±2）°、（8±1）°]、骶倾角［（术后（43±7）°、（42±6）°；末次随访时（42±6）°、（40±5）°］和椎间隙高度［（术后（12.1±1.8）mm、（12.2±1.6）mm；末次随访时（11.6±1.5）mm、（11.0±1.3）mm］相比，差异均无统计学意义。ODI指数方面，后路融合组由术前（32.9±7.1）%恢复至末次随访时的（7.0±2.6）%；斜外侧融合组由术前（32.7±7.7）%恢复至末次随访时的（6.5±2.3）%，与术前相比差异均有统计学意义（P＜0.05）。并发症发生率后路融合组（14.29%）高于斜外侧融合组（11.86%）（P＜0.05）。后路融合组融合率96.4%高于斜外侧融合组（94.9%）（P＜0.05）。随访过程中未发现内固定松动、断裂或椎间融合器移位现象，固定融合部位邻近节段无明显退变。结论 斜外侧椎间融合联合后方肌间隙入路通道下椎弓根螺钉固定和后方肌间隙入路通道下椎弓根螺钉复位固定并椎间融合两种方法用于Ⅰ～Ⅱ度腰椎滑脱的治疗均获得良好的临床效果，但前者固定融合方式临床优势更加明显，操作时间短、创伤小、出血少、对椎管和椎管内神经基本无干扰、椎体复位效果好、安全性高、恢复快等。只要严格掌握适应证，斜外侧椎间融合联合后方肌间隙入路通道下椎弓根螺钉固定可作为Ⅰ～Ⅱ度腰椎滑脱症较好的手术治疗选择。

Abstract:

Objective To compare the advantages and disadvantages of posterior interbody fusion by intermuscular approach and oblique lateral interbody fusion combined with posterior pedicle screw fixation for treating lumbar spondylolisthesis (degree Ⅰ-Ⅱ). Methods A prospective study was conducted on 115 patients who underwent surgical treatment for lumbar spondylolisthesis from June 2016 to June 2018. These patients include 33 males and 82 females, ranging in age from 41 to 72 years, with a mean of (57±7) years. 56 cases (posterior interbody fusion group) were treated by intermuscular approach and 59 cases (oblique lateral interbody fusion group) were treated by oblique lateral approach and posterior pedicle screw fixation. The operative time, intraoperative blood loss, imaging results, clinical results and complications were compared between the two groups. Results All patients were followed up with an average of (27±3) months (range from 12 to 48 months). The operative time and intraoperative blood loss of oblique lateral interbody fusion group were significantly less than posterior interbody fusion group (P<0.05). There was no incision infection and nerve injury were observed in two groups. Besides, the VAS score at 72 h after surgery of oblique lateral interbody fusion group (1.10±0.08) were significantly less than posterior interbody fusion group (1.51±0.15). According to the analysis of variance with repeated measures design, the difference between the posterior group and the oblique lateral fusion group was statistically significant in terms of lumbar lordosis angle and spondylolisthesis rate at postoperation and the last follow-up (P<0.05). There was no statistically significant difference between different groups in spondylolisthesis angle, sacral inclination angle and intervertebral space height. Both the two groups showed significant improvement in ODI during the final follow-up (P<0.05), but the difference between the two groups was not statistically significant. The incidence of complications in the posterior fusion group was significantly higher than in the oblique lateral fusion group (P<0.05). The fusion rate of posterior interbody fusion group was 96.4% and 94.9% in oblique lateral interbody fusion group, while the difference was not statistically significant (P>0.05). During the follow-up, loosening, displacement, breakage of pedicle screw, displacement of intervertebral cages or obvious degeneration of adjacent segments were not observed. Conclusions The posterior interbody fusion by intermuscular approach and the oblique lateral interbody fusion combined with posterior pedicle screw fixation take well clinical results for treating lumbar spondylolisthesis (degree Ⅰ-Ⅱ). Oblique lateral interbody fusion combined with posterior pedicle screw fixation through intermuscular approach takes advantages of quick operation, less trauma, less bleeding, high safety, quick recovery and no interference to spinal canal, which can be a good choice for treatment of lumbar spondylolisthesis (degree Ⅰ-Ⅱ).

备注/Memo

备注/Memo:

基金项目：浙江省医药卫生科技计划项目（2020KY968）

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更新日期/Last Update: 2022-06-17