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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:

2024年01期

页码:

10-18

栏目:

脊柱专题

出版日期:

2024-02-05

文章信息/Info

Title:

Oblique lumbar interbody fusion combined with spinal endoscopy decompression for treatment of degenerative lumbar disease

作者:

高放; 李锋; 方忠

430030武汉，华中科技大学同济医学院附属同济医院骨科

Author(s):

Gao Fang;  Li Feng;  Fang Zhong

Department of orthopaedics, Tongji Hospital Affiliated Tongji Medical College of Huazhong University of Science &Technology, Wuhan 430030, China

关键词:

斜外侧腰椎椎间融合术;  OLIF;  脊柱内镜;  微创;  腰椎退行性疾病

Keywords:

Oblique lumbar interbody fusion;  OLIF;  Spinal endoscope;  Degenerative lumbar disease;  Minimally invasive

DOI:

10.3877/cma.j.issn.2096-0263.2024.01.003

文献标志码:

A

摘要:

目的 观察斜外侧腰椎椎间融合术（OLIF）联合脊柱内镜减压治疗腰椎退行性疾病的临床疗效。方法 回顾性分析2015年10月至2020年5月于我院接受OLIF联合脊柱内镜减压治疗腰椎退行性疾病患者（观察组）的临床资料，并与同期行微创TLIF手术患者（对照组）进行对比。记录两组手术时间、术中出血量、术后引流量、术后平均住院天数及并发症等一般情况，利用疼痛VAS评分、ODI指数评估临床疗效，采用腰椎X线或CT三维重建评估椎间隙高度、椎间孔高度和大小及椎间融合率等改变情况。结果 59例患者均获得随访，观察组26例，对照组33例，平均随访时间为（24.2±7.8）月、（24.7±8.1）月。观察组术中出血量、术后引流量及术后平均住院时间均小于对照组（P＜0.05），而手术时间和平均住院费用大于对照组（P＜0.05）。观察组术后切口疼痛VAS评分 （2.0±1.5）分， 低于对照组（4.0±1.4）分（P＜0.05）。两组术前及术后各时间点腰痛VAS评分、下肢痛VAS评分、ODI指数经重复测量设计的方差分析，不同时间点间差异均有统计学意义（P＜0.05），随观察时间延长呈逐渐降低趋势。组别间差异均无统计学意义，组别与时间点间均无交互作用。两组术前、术后各时间点椎间隙高度、椎间孔高度和大小经重复测量设计的方差分析，不同时间点间差异均有统计学意义（P＜0.05），组别与时间点间均存在交互作用（P＜0.05）。椎间隙及椎间孔高度组别间差异有统计学意义（P＜0.05），椎间孔大小组别间差异无统计学意义。进一步简单效应分析，组间比较，各时间点除术前时间点外观察组椎间隙高度、椎间孔高度和大小均大于对照组（P＜0.05）。观察组术后1年测量椎间隙高度、椎间孔高度和大小为[（13.0±2.2）mm、（19.5±0.3）mm、（158.4±4.4）mm2]，大于对照组[（10.0±2.4）mm、（18.1±0.2）mm、（142.0±3.9）mm2，P＜0.05]。组内比较，观察组术后各时点椎间隙高度、椎间孔高度和大小均较术前明显增大（P＜0.05）。两组融合率和并发症发生率差异无统计学意义。结论 OLIF联合脊柱内镜减压手术全程微创、疗效满意，并能有效地恢复椎间隙高度及椎间孔大小，为腰椎退行性疾病的治疗提供新选择。

Abstract:

Objective To evaluate the clinical effect of oblique lumbar interbody fusion (OLIF) combined with spinal endoscopy decompression for the treatment of degenerative lumbar disease. Methods Patients with lumbar degenerative disease who underwent OLIF combined with spinal endoscopy at our hospital between October 2015 and May 2020 were retrospectively analysed (observation group). The results were compared with patients who underwent minimally invasive TLIF during the same period (control group). Operative time, blood loss, postoperative stay, hospital costs and complications were recorded. VAS and ODI scores were used to assess the clinical efficacy of surgery. Radiological parameters were measured by X-ray or three-dimensional CT. Results All 59 patients were followed up. The observation group consisted of 26 cases with a mean follow-up of (24.2±7.8) months.The control group consisted of 33 cases with a mean follow-up of (24.7±8.1) months.The observation group had lower intraoperative blood loss, postoperative drainage volume and average postoperative hospital stay compared to the control group. However, operative time and average hospital costs were higher in the observation group than in the control group (P<0.05). The postoperative incisional pain VAS score in the observation group [(2.0±1.5) points] was significantly lower than that in the control group [(4.0±1.4) points, P<0.001)]. Repeated measures analysis of variance (ANOVA) was performed to examine back pain VAS scores, leg pain VAS scores, and ODI index across groups and time points. The results showed no significant differences between groups, significant differences between time points (P<0.05) and no interaction between groups and time points. The VAS scores of back pain, VAS scores of leg pain and ODI index at each time point after surgery were significantly lower in both groups compared to pre-surgery scores (P<0.05) and gradually decreased over time. The size and height of the intervertebral foramen, as well as the height of the intervertebral space, underwent analysis through repeated measures ANOVA across time points and groups. Results indicate statistically significant differences between time points and significant interaction effects between groups and time points for all three parameters (P<0.05). Statistically significant differences were observed between the groups in terms of intervertebral space height and intervertebral foramen height (P<0.05), but not in terms of intervertebral foramen size. Further analysis revealed that the intervertebral space height, intervertebral foramen height and size were consistently greater in the observation group than in the control group at all time points except preoperative (P<0.05). Specifically, at 1 year after surgery, the intervertebral space height, foramen height, and size in the observation group were [(13.0±2.2)mm, (19.5±0.3)mm, (158.4±4.4)mm2], which were significantly greater than those in the control group [(10.0±2.4)mm, (18.1±0.2)mm, (142.0±3.9)mm2, P<0.05]. Furthermore, in the observation group, the intervertebral space height, intervertebral foramen height and size were significantly larger at all time points after surgery compared to preoperative (P<0.05). However, there were no significant differences in fusion rate and complication rate between the two groups. Conclusions The combination of OLIF with spinal endoscopic decompression surgery is minimally invasive and effective, and can also effectively restore the height of the intervertebral space and the size of the intervertebral foramen, providing a new option for the treatment of lumbar degenerative disease.

备注/Memo

备注/Memo:

基金项目：国家自然科学基金项目（81472133）

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更新日期/Last Update: 2024-08-01