目的 探讨斜外侧腰椎间融合术（oblique lateral interbody fusion，OLIF）对退行性腰椎管狭窄症（degenerative lumbar spinal stenosis，DLSS）的治疗效果。 方法 选取我院DLSS患者103例，按手术方式分为OLIF组（n=51，行OLIF），腰椎后路减压内固定融合术（posterior lumbar intervertebral fusion，PLIF）组（n=52，行PLIF）。对比两组手术情况、疗效与围手术期血清炎症因子、氧化应激指标、脊髓功能、腰腿疼痛（VAS）、腰椎功能（JOA）。 结果 OLIF组围手术期指标、术后1年疗效优于PLIF组（P<0.05）；OLIF组术后1 d、3 d血清炎症因子水平低于PLIF组（P<0.05）；OLIF组术后1 d、3 d血清晚期蛋白氧化产物、丙二醛水平低于PLIF组，超氧化物歧化酶水平高于PLIF组（P<0.05）；OLIF组术后6个月、1年胫神经和腓总神经传导速度、JOA评分高于PLIF组，潜伏期、腰腿疼痛VAS评分低于PLIF组（P<0.05）。 结论 OLIF治疗DLSS效果显著，创伤更轻微。
Abstract
Objective To investigate the effect of oblique lateral interbody fusion (OLIF) in the treatment of degenerative lumbar spinal stenosis (DLSS). Methods A total of 103 DLSS patients in our hospital were selected. According to the treatment method, they were divided into an OLIF group (n=51, OLIF operation), a posterior lumbar intervertebral fusion (PLIF) group (n=52, PLIF operation). The curative effect, surgical conditions and perioperative serum inflammatory factors, oxidative stress indicators, spinal cord function, the Visual Analogue Scale (VAS), the Japanese Orthopedic Association (JOA) were compared between the two groups. Results The perioperative index and the effect of 1 year after operation in the OLIF group were better than those in the PLIF group (P<0.05). The levels of serum inflammatory factors in the OLIF group were lower than those in the PLIF group at 1 day and 3 days after operation (P<0.05). The levels of serum advanced oxidation protein products (AOPP) and malondialdehyde (MDA) in the OLIF group were lower than those in the PLIF group at 1 and 3 days after the operation, and the superoxide dismutase (SOD) level was higher than that in the PLIF group (P<0.05). The nerve conduction velocity (NCV) level and JOA score of the tibial nerve and common peroneal nerve in the OLIF group were higher than those in the PLIF group at 6 months and 1 year after the operation, while the latency (DL) and the VAS scores of waist and leg pain were lower than those of the PLIF group (P<0.05). Conclusions OLIF is effective in the treatment of DLSS, with less trauma.
关键词
斜外侧腰椎间融合术； /
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腰椎后路减压内固定融合术； /
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炎症因子； /
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氧化应激
Key words
Oblique lateral interbody fusion; /
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Posterior lumbar intervertebral fusion; /
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Inflammatory factors; /
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Oxidative stress
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参考文献
[1] 楼超, 刘飞俊, 何登伟, 等. 经皮内镜下切除术联合斜外侧椎间融合术治疗合并间盘脱出的腰椎退行性疾病[J]. 中华骨科杂志, 2020, 40(8): 507-514. DOI: 10.3760/cma.j.cn121113-20200316-00164.
[2] 林斌, 吴松松, 李曦, 等. 斜外侧椎间融合术联合侧方椎体螺钉固定治疗腰椎间隙感染的早期临床疗效[J]. 中国脊柱脊髓杂志, 2019, 29(8): 698-706. DOI: 10.3969/j.issn.1004-406X.2019.08.04.
[3] Park S, Kim HJ, Ko BG, et al. The prevalence and impact of sarcopenia on degenerative lumbar spinal stenosis[J]. Bone Joint J, 2016, 98-B(8): 1093-1098. DOI: 10.1302/0301-620X.98B8.37623.
[4] 郭徽灵, 胡世平, 吴宏, 等. 单侧改良TLIF联合全椎管潜行减压与传统PLIF对腰椎管狭窄症的临床比较[J]. 福建医科大学学报, 2017, 51(1): 71-73. CNKI: SUN:FJYD.0.2017-01-019.
[5] 廖烨晖, 叶入裴, 唐强, 等. 超声骨刀单侧开窗双侧减压后路腰椎椎体间融合术治疗退变性腰椎管狭窄症[J]. 中国修复重建外科杂志, 2019, 33(4): 31-37. DOI: 10.7507/1002-1892.201808037.
[6] Kamal RM Woods, James B Billys, Richard A Hynes. Technical description of oblique lateral interbody fusion at L1-L5 (OLIF25) and at L5-S1 (OLIF51) and evaluation of complication and fusion rates[J]. Spine J, 2017, 17(4): 545-553. DOI: 10.1016/j.spinee.2016.10.026.
[7] 赖居易, 何升华, 孙志涛, 等. 经皮椎间孔镜联合针刺治疗腰椎间盘突出症临床观察[J]. 中华中医药杂志, 2017, 32(3): 1387-1390. CNKI: SUN:BXYY.0.2017-03-142.
[8] 宋永兴, 曾忠友, 宋国浩, 等. 通道下经肌间隙入路联合固定并椎间融合术治疗老年人腰椎退行性疾病的近期疗效[J]. 中华老年医学杂志, 2018, 37(11): 1266-1271. DOI: 10.3760/cma.j.issn.0254-9026. 2018. 11.020.
[9] 张建锋, 范顺武, 方向前, 等. 斜外侧椎间融合术在单节段腰椎间盘退行性疾病中的应用[J]. 中华骨科杂志, 2017, 37(2): 80-88. DOI: 10.3760/cma.j.issn.0253-2352.2017.02.003.
[10]刘恩, 栗凯华, 吕飞, 等. 斜外侧腰椎椎间融合术对退行性腰椎椎管狭窄症患者炎症因子的影响[J]. 国际外科学杂志, 2020, 47(3): 181-187. DOI: 10.3760/cma.j.issn.1673-4203.2020.03.007.
[11] 周明华, 周先富. 针药并举治疗腰椎管狭窄对其影像学指标、炎性因子的影响分析[J]. 中华中医药学刊, 2017, 35(4): 1047-1049. CNKI: SUN:ZYHS.0.2017-04-077.
[12] Malik A, Sharma D, Zhu QF, et al. IL-33 regulates the IgA-microbiota axis to restrain IL-1α–dependent colitis and tumorigenesis[J]. J Clin Invest, 2016, 126(12): 4469-4481. DOI: 10.1172/JCI88625.
[13] Huang CH, Chen YJ, Chao TY, et al. The association between p38 MAPK-mediated TNF-α/TNFR2 up-regulation and 2-(4-Aminophenyl)-7-methoxybenzothiazole-induced apoptosis in human leukemia U937 cells[J]. J Cell Physiol, 2016,231(1): 130-141. DOI: 10.1002/jcp. 25064.
[14] 苏德望, 朱艳丽, 杜井峰, 等. 腹腔镜结直肠癌根治术对结直肠癌患者氧化应激及能量代谢的影响[J]. 重庆医学, 2019, 48(10): 173-175. DOI: 10.3969/j.issn.1671-8348.2019.10.042.
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