高位退变性腰椎滑脱的斜外侧腰椎间融合椎弓根钉固定
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河南省洛阳正骨医院(河南省骨科医院)

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OLIF combined with pedicle screw in the treatment of high degenerative lumbar spondylolisthesis
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Henan Luoyang Orthopedic Hospital/Henan Provincial Orthopedic Hospital

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    摘要:

    [目的] 评价斜外侧椎间融合术(oblique lateral interbody fusion,OLIF)联合Wiltse入路椎弓根钉固定治疗高位退变性腰椎滑脱症的临床疗效。[方法] 回顾性分析2018年3月至2019年6月本院收治的43例高位退变性腰椎滑脱症患者的临床资料。根据医患沟通结果,20例采用OLIF联合Wiltse入路椎弓根钉固定治疗(OLIF组),23例采用经椎间孔入路腰椎椎间融合术(transforaminal lumbar interbody fusion,TLIF)(TLIF组)。比较两组围手术期、随访及影像资料。[结果] 所有患者均顺利完成手术,OLIF组在手术时间、切口长度、术中失血量、术后引流量、下地行走时间和术后住院时间上均显著优于TLIF组 (P?0.05)。所有患者均获随访12个月以上,平均随访(22.70±6.51)个月。OLIF组恢复完全负重活动时间显著早于TLIF组(P<0.05)。随时间推移,两组VAS、ODI评分均显著减少(P<0.05),而JOA评分显著增加(P<0.05)。相应时间点,两组间VAS、ODI及JOA评分的差异均无统计学意义(P>0.05)。影像方面,与术前相比,末次随访时两组患者椎间隙高度、椎间孔高度、腰椎前凸角均显著增加(P<0.05);而椎体滑脱率均明显减少(P<0.05)。相应时间点,两组上述指标的差异无统计学意义(P>0.05)。术后6月和末次随访时时,OLIF组融合等级显著优于TLIF组(P<0.05)。[结论] OLIF联合Wiltse入路椎弓根钉固定治疗高位退变性腰椎滑脱症疗效满意,具有创伤小、恢复快、术后并发症少等优点,值得临床广泛推广。

    Abstract:

    OLIF combined with pedicle screw in the treatment of high degenerative lumbar spondylolisthesis//Tie Weibin1, Niu Hui1, Liu Hongjian2* 1Department of Orthopaedics, Luoyang Zhenggu Hospital of Henan Province /Henan Provincial Orthopedic Hospital, Zhengzhou 450016, China 2 Department of Orthopaedics, First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China Abstract [Objective] To assess the clinical effect of oblique lumbar interbody fusion (OLIF) combined with Wiltse approach pedicle screw fixation in the treatment of high degenerative lumbar spondylolisthesis. [Methods] The clinical data of 43 patients with high degenerative lumbar spondylolisthesis from March 2018 to June 2019 were retrospectively analyzed. According to the consequences of preoperative doctor-patient communication, 43 petients received OLIF (OLIF group), while the other 23 patients underwent TLIF surgery(TLIF group).The perioperative follow-up and imagine data were compared between the two groups. [Results] All patients had operation performed successfully. The OLIF group proved significantly superior to the TLIF group in terms of operation time, incision length, intraoperative blood loss, postoperative drainage, the time to return walking,and hospital stay (P<0.05). All patients in both groups were followed up for more than 12 months, with an average of (22.70±6.51) months. The OLIF group resumed full weight-bearing activity significantly earlier than the TLIF group (P<0.05). The VAS and ODI scores significantly decreased (P<0.05), while JOA scores was significantly increased in both groups over time (P<0.05). There were no significant differences in VAS, ODI and JOA scores between the two groups at corresponding time points (P>0.05). In terms of imagine evaluation, the intervertebral height, foraminal height, and lumbar lordosis of the two groups were significantly increased compared with those preoperatively (P<0.05). However,the percentage of vertebral slippage were significantly reduced in both groups(P<0.05). At corresponding time points, there was no statistically significant difference in the above indicators between the two groups(P>0.05). [Conclusion] OLIF combined with Wiltse approach pedicle screw has a satisfactory effect in the treatment of high degenerative lumbar spondylolisthesis, with the advantages of less trauma, quick recovery and less postoperative complications, which is worthy of clinical recommendation. key words: Lumbar spondylolisthesis; Oblique lumbar interbody fusion; Wiltse approach; pedicle screw

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  • 收稿日期:2021-12-06
  • 最后修改日期:2022-05-27
  • 录用日期:2022-06-07
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