斜外侧腰椎椎间融合术联合后路固定与单独应用对退行性滑脱节段力线改善效果的比较

目的:探讨斜外侧椎间融合术(oblique lumbar interbody fusion，OLIF)联合后路固定与单纯OLIF手术（stand-alone OLIF）对治疗腰椎退行性滑脱(degenerative spondylolisthesis，DS)节段力线的影响。 方法:连续性收集并回顾性分析2017年7月至2019年12月共有63例接受了OLIF手术并未行后路截骨术的DS患者资料。其中男15例，女48例，年龄(64.1±8.7)岁(范围:46～81岁)。据手术的类型分为:单纯OLIF手术组17例，OLIF手术联合后路固定组46例。据手术的节段数分为：单节段手术53例，双节段手术10例。分别于术前与术后3天所有患者行腰椎标准侧位X线片检查，并分别进行手术节段参数测量。其中影像学参数包括椎间高度(Disc height, DH)、滑移率(Slip ratio, SR)和节段性脊柱前凸(Segmental Lordosis, SL)。本研究中考虑了混杂因素，包括小关节退变程度、融合节段和融合器位置等因素。 结果:共纳入73例手术节段，其中单纯OLIF手术组21例节段，OLIF手术联合后路固定组52例节段。在小关节退变程度、融合节段和融合器位置方面，两组没有显著差异。在节段力线方面，单纯OLIF手术组与OLIF手术联合后路固定组SL改善分别为(1.5±°和5.0±°)，DH-A改善分别为 (6.2±mm和7.1± mm)，DH-P 改善分别为(4.7±mm和4.4±mm)和SR改善分别为 (5.3±%和11.6±%)，差异均有统计学意义(P<0.05)。OLIF手术联合后路固定比单纯OLIF手术可以显著提高SL(3.5°)和改善 SR (6.3%)。 结论:OLIF手术联合后路固定比单纯OLIF手术对于节段力线改善效果更好，特别是节段性前凸角度和滑脱率。

Comparison of segmental alignment outcomes in lumbar degenerative spondylolisthesis after single OLIF and OLIF with posterior fixation

Objective To compare radiographic outcomes of segmental alignment of patients with lumbar degenerative spondylolisthesis (DS) after single technique and combined posterior fixation in oblique lumbar interbody fusion (OLIF) procedure, and to evaluate the effect of posterior fixation on lumbar segmental alignment. Methods A total of 63 patients (73 DS segments) with DS underwent OLIF surgery without posterior osteotomy with or without additional posterior fixation from July 2017 to December 2019 were selected. Seventeen patients were treated with single OLIF and 46 patients were treated with OLIF combined with posterior fixation. There were 53 patients underwent single-level surgery and 10 patients underwent double-level surgery. The radiographic parameters including disc height (DH), slip ratio (SR), and segmental lordosis (SL) were measured on plain radiographs before operation and 3 d after operation. Results These were 21, 52 segments in single OLIF and OLIF combined with posterior fixation groups, respectively. There was no significant difference among facet degeneration, level fused, and cage position between the two groups. In single OLIF and OLIF combined with posterior fixation groups, SL about improved 1.5° and 5.0°, and SR about improved 5.3% and 11.6%, respectively (P<0.001). SL improved 3.5° and SR improved 6.3% by posterior fixation based on OLIF. Conclusions OLIF combinded with posterior fixation has better improvement effect on radiographic parameters in DS patients than single OLIF, especially in SR and SL.