论文部分内容阅读
目的:评估斜外侧椎间融合术（oblique lumbar interbody fusion，OLIF）联合后路固定治疗退行性腰椎滑脱（degenerative spondylolisthesis，DS）对手术节段力线的影响。方法:回顾性分析2017年7月至2019年12月行OLIF联合后路固定治疗40例DS患者的病历资料，男7例，女33例；年龄（65.7±9.06）岁（范围：45~81岁）。总滑脱节段数为43个节段，Ln 4，5 37个节段，Ln 3，4 5个节段，Ln 2，3 1个节段。根据减压方式不同将患者分为直接减压组和间接减压组，22例患者23个节段联合椎板开窗进行直接减压治疗（直接减压组），18例患者20个节段未行椎板开窗减压治疗（间接减压组）。通过术前CT和术中透视图像测量手术节段力线参数，包括椎间隙高度（disc height，DH），滑移率（slipratio，SR）和节段前凸角度（segmental lordosis，SL）。采用重复测量单因素方差分析比较在融合器置入前、融合器置入后及后路固定后节段力线的影像学参数，再采用Bonferroni检验对节段力线的影像学参数进行两两比较。n 结果:在OLIF联合后路固定手术中不同操作阶段节段力线的影像学参数比较，差异均有统计学意义[DH（n F=147.786，n P<0.001），SR（n F=83.754，n P<0.001），SL（n F=38.296，n P<0.001）]。即融合器置入后DH由（7.99±1.39） mm增加至（11.69±1.72） mm（n P< 0.001），SR由10.67%±4.67％降低至8.66%±4.50％（n P=0.001），SL由7.26°±2.73°增加至7.85°±2.30°（n P=0.425）；联合后路辅助固定后SR进一步降低至2.07%±4.00％（n P<0.001），SL由进一步增加至10.72°±3.08°（n P< 0.001），而DH则无明显变化（n P=1.000）。直接减压组和间接减压组患者分别在融合器置入前、融合器置入后及后路固定后节段力线影像学参数的比较，差异均无统计学意义。n 结论:OLIF联合后路固定治疗DS能进一步减少腰椎退行性滑脱患者的滑移率，并增加手术节段前凸角度，同时联合椎板开窗进行直接减压不会对腰椎节段力线产生明显影响。“,”Objective:To evaluate the effect of oblique lateral interbody fusion (OLIF) combined with posterior fixation on segmental alignment in the treatment of degenerative spondylolisthesis (DS).Methods:The clinical data of 40 patients with DS who underwent OLIF combined with posterior fixation from July 2017 to December 2019 were retrospectively analyzed. There were 7 males and 33 females, aged 45-81 years, with an average age of 65.7±9.06 years. The total number of slip segments was 43, including 37 levels at Ln 4, 5, 5 levels at Ln 3, 4, and 1 level at Ln 2, 3. According to the decompression methods, the patients were divided into two groups. 22 patients with 23 levels were treated with direct decompression combined with laminectomy, and 18 patients with 20 levels were treated with indirect decompression without laminectomy. All patients underwent preoperative and intraoperative imaging examination. The disc height (DH), slip ratio (SR) and segmental lordosis (SL) were measured by preoperative CT and intraoperative fluoroscopy images. One-way repeated measures ANOVA was used to compare the radiographic parameters of the segmental alignment prior to cage implantation, following cage insertion and posterior fixation. Bonferroni test was used to compare the radiographic parameters between groups.n Results:In the OLIF combined with the posterior fixation, there were statistically significant differences in the radiographic parameters of segmental alignment at different stages of operation [DH (n F=147.786, n P<0.001) , SR (n F=83.754, n P<0.001) , SL (n F=38.296, n P<0.001) ]. DH increased from 7.99±1.39 mm to 11.69±1.72 mm (n P<0.001), SR decreased from 10.67%±4.67% to 8.66%±4.50% (n P=0.001) and SL increased from 7.26°±2.73° to 7.85°±2.30° (n P=0.425). After combined posterior fixation, SR further decreased from 8.66%±4.50% to 2.07%±4.00% (n P<0.001), SL further increased from 7.85°±2.30° to 10.72°±3.08° (n P<0.001), and DH had no significant change (n P=1.000). There was no significant difference in radiographic parameters between the direct decompression group and the indirect decompression group when prior to cage implantation, following cage insertion and following posterior fixation, respectively.n Conclusion:OLIF combined with posterior fixation in the treatment of DS can further reduce the slip rate of patients with lumbar degenerative spondylolisthesis and increase the lordosis angle of the surgical segment. At the same time, the direct decompression combined with laminectomy has no significant effect on the segmental alignment.