摘要
目的探讨斜外侧椎间融合(OLIF)联合后方肌间隙入路内固定治疗老年腰椎管狭窄症的疗效。方法回顾性收集2021年2月至2024年6月在河北北方学院附属第一医院进行手术治疗的136例老年腰椎管狭窄症患者,按照治疗方法不同分为OLIF组(n=72)和PLIF组(n=64)。OLIF组行OLIF联合后方肌间隙入路内固定治疗,PLIF组行后方肌间隙入路椎弓根螺钉固定并椎间融合治疗。比较两组患者手术一般情况;比较两组术前、术后1周、末次随访时的腰腿痛视觉模拟评分法(VAS)评分、Oswestry功能障碍指数(ODI),并分析影像学参数;并统计两组并发症发生情况。结果OLIF组术中出血量为(101.25±18.37)mL,少于PLIF组[(242.57±46.79)mL],OLIF组术后卧床时间、术后住院时间分别为(40.21±7.64)h、(4.78±1.25)d,均短于PLIF组[(61.28±10.37)h、(6.57±2.06)d],差异均有统计学意义(P<0.05);两组手术时间比较,差异无统计学意义(P>0.05)。术后1周两组VAS评分、ODI评分均较术前降低,且末次随访时,两组评分更低,差异均有统计学意义(P<0.05)。术后1周OLIF组VAS评分为(3.87±0.63)分,显著低于PLIF组[(4.21±0.51)分],差异有统计学意义(P<0.05);末次随访时两组VAS评分、术后1周和末次随访时ODI评分比较,差异均无统计学意义(P>0.05)。术后1周和末次随访时两组各病变节段椎间隙高度、Cobb角均较术前均明显改善,差异均有统计学意义(P<0.05);但组间影像学参数比较,差异均无统计学意义(P>0.05)。两组病例均实现椎间融合。两组并发症发生率比较,差异无统计学意义(P>0.05)。结论OLIF联合后方肌间隙入路内固定治疗老年腰椎管狭窄症,相比后方肌间隙入路PLIF术更具微创优势,能够减少手术出血,促进术后恢复,且具有相当的腰椎功能恢复效果。
Objective To investigate the efficacy of oblique lateral interbody fusion(OLIF)combined with posterior intermuscular approach internal fixation in the treatment of elderly patients with lumbar spinal stenosis.Methods A total of 136 elderly patients with lumbar spinal stenosis who underwent surgical treatment in the First Affiliated Hospital of Hebei North University from February 2021 to June 2024 were retrospectively collected.According to different treatment methods,they were divided into the OLIF group(n=72)and PLIF group(n=64).The OLIF group was treated with OLIF combined with posterior intermuscular space approach internal fixation,and the PLIF group was treated with posterior intermuscular space approach pedicle screw fixation and intervertebral fusion.The general conditions of the two groups were compared.Before and after operation,the visual analogue scale(VAS)score and Oswestry disability index(ODI)before operation,1 week after operation and at the last follow-up were compared between the two groups,and the imaging parameters were compared and analyzed.The complications of the two groups were statistically analyzed.Results The intraoperative blood loss in the OLIF group was(101.25±18.37)mL,which was less than that in the PLIF group[(242.57±46.79)mL],the postoperative bed rest time and postoperative hospital stay in the OLIF group were(40.21±7.64)h and(4.78±1.25)d,respectively,which were shorter than those in the PLIF group[(61.28±10.37)h and(6.57±2.06)d],and the differences were statistically significant(P<0.05).There was no statistically significant difference in operation time between the two groups(P>0.05).The VAS score and ODI score of the two groups at 1 week after operation were lower than those before operation,and the scores of the two groups were lower at the last follow-up,the differences were statistically significant(P<0.05).The VAS score of the OLIF group was(3.87±0.63)points at 1 week after operation,which was significantly lower than that of the PLIF group[(4.21±0.51)points],and the difference was statistically significant(P<0.05);there were no statistically significant differences in VAS score at the last follow-up,ODI score at 1 week after operation and at the last follow-up between the two groups(P>0.05).The height of intervertebral space and Cobb angle of each lesion segment at 1 week after operation and at the last follow-up were significantly improved compared with those before operation,and the differences were statistically significant(P<0.05);however,there were no statistically significant differences in imaging parameters between the two groups(P>0.05).Intervertebral fusion was achieved in both groups.There was no statistically significant difference in the incidence of complications between the two groups(P>0.05).Conclusion Compared with PLIF via posterior intermuscular approach,OLIF combined with posterior intermuscular approach internal fixation is more minimally invasive in the treatment of elderly patients with lumbar spinal stenosis.It can reduce surgical bleeding,promote postoperative recovery,and has a considerable effect on lumbar function recovery.
作者
罗永洁
冯东伟
王康
李东
LUO Yongjie;FENG Dongwei;WANG Kang(Department of Pain,the First Affiliated Hospital of Hebei North University,Zhangjiakou Hebei 075000,China)
出处
《临床和实验医学杂志》
2025年第22期2402-2405,共4页
Journal of Clinical and Experimental Medicine
基金
2025年度河北省医学科学研究课题计划(编号:20250896)。
关键词
腰椎管狭窄症
斜外侧椎间融合
后方肌间隙入路内固定
术后恢复
腰椎功能
Lumbar spinal stenosis
Oblique lateral interbody fusion
Internal fixation through posterior intermuscular space approach
Postoperative recovery
Lumbar function
