这是一项单中心回顾性研究。经椎间孔腰椎椎间融合术(MIS-TLIF)的微创技术,斜腰椎椎间融合术(OLIF),经皮椎间孔镜下腰椎椎间融合术(Endo-TLIF)已广泛应用于腰椎退行性疾病。本研究分析了上述三种微创技术对L4/L5退行性腰椎滑脱的短期和中期临床效果。在这项回顾性研究中,98例L4/L5退行性腰椎滑脱患者接受MIS-TLIF,107收到OLIF,114人接受了Endo-TLIF.所有患者均随访至少1年。我们比较了病人的数据,包括年龄,性别,体重指数(BMI),Oswestry残疾指数(ODI),下腰痛视觉模拟评分(VAS-B),疼痛视觉模拟评分(VAS-L),手术时间,失血,排水量,住院,并发症,和神经状态。此外,我们进行了影像学评估,包括腰椎前凸角(LLA),椎间盘高度(DH)和椎间融合状态。在年龄上没有显着差异,性别,BMI,术前ODI,术前VAS-B,术前VAS-L,术前LLA,或术前DH。接受OLIF的患者失血量明显减少,较低的排水量,住院时间短于接受MIS-TLIF或Endo-TLIF的患者(P<0.05)。术后6个月和12个月OLIF组VAS-B较MIS-TLIF和Endo-TLIF组明显下降(P<0.05)。术后6个月,Endo-TLIF组VAS-L较MIS-TLIF和OLIF组明显下降(P<0.05)。术后6个月OLIF组ODI明显优于MIS-TLIF和Endo-TLIF组(P<0.05)。三组间并发症发生率和医疗费用差异无统计学意义。OLIF组随访LLA和DH变化明显低于其他组(P<0.05)。术后6、12个月OLIF组椎间融合率明显高于其他组(P<0.05)。总之,而MIS-TLIF,OLIF,和Endo-TLIF技术可以有效治疗L4/5退行性腰椎滑脱患者,OLIF有更多的好处,包括减少手术失血,住院时间缩短,较小的排水量,对背痛的功效,有效维持腰椎前凸角和椎间盘高度,和更高的融合率。OLIF应该是L4/5退行性腰椎滑脱患者的首选手术治疗方法。
This was a single-centre retrospective study. Minimally invasive techniques for transforaminal lumbar interbody fusion (MIS-TLIF), oblique lumbar interbody fusion (OLIF), and percutaneous endoscopic transforaminal lumbar interbody fusion (Endo-TLIF) have been extensively used for lumbar degenerative diseases. The present study analyses the short-term and mid-term clinical effects of the above three minimally invasive techniques on L4/L5 degenerative spondylolisthesis. In this retrospective study, 98 patients with L4/L5 degenerative spondylolisthesis received MIS-TLIF, 107 received OLIF, and 114 received Endo-TLIF. All patients were followed up for at least one year. We compared patient data, including age, sex, body mass index (BMI), Oswestry disability index (ODI), visual analogue scale of low back pain (VAS-B), visual analogue scale of leg pain (VAS-L), surgical time, blood loss, drainage volume, hospital stay, complications, and neurological status. Moreover, we performed imaging evaluations, including lumbar lordosis angle (LLA), disc height (DH) and intervertebral fusion status. No significant differences were noted in age, sex, BMI, preoperative ODI, preoperative VAS-B, preoperative VAS-L, preoperative LLA, or preoperative DH. Patients who underwent OLIF had significantly decreased blood loss, a lower drainage volume, and a shorter hospital stay than those who underwent MIS-TLIF or Endo-TLIF (P < 0.05). The VAS-B in the OLIF group significantly decreased compared with in the MIS-TLIF and Endo-TLIF groups at 6 and 12 months postoperatively (P < 0.05). The VAS-L in the Endo-TLIF group significantly decreased compared with that in the MIS-TLIF and OLIF groups at 6 months postoperatively (P < 0.05). The ODI in the OLIF group was significantly better than that in the MIS-TLIF and Endo-TLIF groups at 6 months postoperatively (P < 0.05). No statistically significant differences in the incidence of complications and healthcare cost were found among the three groups. Follow-up LLA and DH changes were significantly lower in the OLIF group than in the other groups (P < 0.05). The intervertebral fusion rate was significantly higher in the OLIF group than in the other groups at 6 and 12 months postoperatively (P < 0.05). In conclusion, while MIS-TLIF, OLIF, and Endo-TLIF techniques can effectively treat patients with L4/5 degenerative spondylolisthesis, OLIF has more benefits, including less operative blood loss, a shorter hospital stay, a smaller drainage volume, efficacy for back pain, effective maintenance of lumbar lordosis angle and disc height, and a higher fusion rate. OLIF should be the preferred surgical treatment for patients with L4/5 degenerative spondylolisthesis.