OLIF联合后路经皮椎弓根螺钉内固定技术与传统TLIF治疗腰椎滑脱症的近期疗效对比

Comparison of Early Clinical Effect between OLIF Combined with Posterior Per-cutaneous Pedicle Screw Fixation Technique and Conventional TLIF in the Treatment of Lumbar Spondylolisthesis

摘要: 目的：比较斜外侧入路(OLIF)联合后路经皮椎弓根螺钉内固定技术与传统经椎间孔入路椎间融合术(TLIF)治疗腰椎滑脱症的近期临床疗效并明确OLIF手术适应证。方法：回顾性分析新疆医科大学第一附属医院自2021年1月至2023年2月收治的54例符合纳入标准的腰椎滑脱症患者资料。根据手术入路不同，分为OLIF + 后路经皮椎弓根螺钉固定组(21例)和TLIF + 后路椎弓根螺钉固定组(33例)。观察围术期情况(手术时间、术中出血量等)；同时，比较手术前后腰痛视觉模拟疼痛评分(VAS)、Oswestry功能障碍指数(ODI)、影像学相关指标(椎间隙高度、椎间孔高度、腰椎前凸角、融合节段前凸角和椎体滑脱率)。结果：54例患者均获得6个月随访。与TLIF组相比，OLIF组术中出血量、术后住院天数、术后3 d VAS评分及ODI指数，均少于TLIF组，但手术时间较长，差异有统计学意义(均P < 0.05)。但两组术后6个月疼痛VAS评分及ODI指数差异无统计学意义(P > 0.05)。OLIF组术后3 d、3个月椎间隙高度、椎间孔高度优于TLIF组，差异有统计学意义(P < 0.05)。但两组术后6个月时椎间隙高度、椎间孔高度差异无统计学意义(P > 0.05)。TLIF组与OLIF组术后3 d、6个月时腰椎前凸角、融合节段前凸角和腰椎滑脱率差异无统计学意义(P > 0.05)。结论：与TLIF相比，OLIF的住院时间更短、术中失血更少、术后疼痛缓解更快、术后功能恢复获益更好，在轻中度腰椎滑脱且椎管内游离髓核较少的情况下推荐应用OLIF联合后路经皮椎弓根螺钉内固定技术。

Abstract: Objective: To compare the short-term clinical outcomes of oblique lumbar interbody fusion (OLIF) combined with posterior percutaneous pedicle screw fixation and conventional transforaminal lumbar interbody fusion (TLIF) for treatment of lumbar spondylolisthesis and define the indications for OLIF surgery. Methods: A retrospective study was performed on 54 cases of patients with lum-bar spondylolisthesis who were admitted from January 2021 to February 2023. Included patients were divided into 2 groups according to the surgical techniques: TLIF (transforaminal lumbar in-terbody fusion) (n = 33) and OLIF + PSF (OLIF combined with posterior spinal fixation) (n = 21). The perioperative conditions (operation time, length of hospital stay, intraoperative blood loss, etc.); at the same time, visual analogue scale (VAS), Oswestry dysfunction index (ODI), imaging related in-dicators (intervertebral space height, intervertebral foramen height, lumbar lordosis, fused seg-mental lordosis and vertebral slippage rate) were compared before and after surgery. Results: Fif-ty-four patients were followed up 6 months. Compared with the TLIF group, the OLIF group had less intraoperative blood loss and shorter length of hospital stay, as well as VAS and ODI 3 days after operation were lower, but the operation time was longer, the difference was statistically significant (P < 0.05). However, there was no significant difference between two groups in the postoperative VAS score and ODI score after 6 months (P > 0.05). The OLIF group was significantly superior to the TLIF group in the height of the vertebral space and the height of the intervertebral foramina at 3 days and 3 months postoperatively (P < 0.05). However, there was no significant different between two groups at 6 months follow-up (P > 0.05). Additionally, there were no significant differences be-tween two groups in the lumbar lordosis, fused segmental lordosis and vertebral slippage rate of spondylolisthesis at 3 days and 6 months postoperatively (P > 0.05). Conclusion: Compared with TLIF, OLIF has shorter hospital stay, less intraoperative blood loss, faster postoperative pain relief, and better benefit from postoperative functional recovery, and the combination of OLIF with poste-rior percutaneous pedicle screw internal fixation technique is recommended in mild to moderate lumbar spondylolisthesis and less intraspinal free nucleus pulposus.