改良侧方入路腰椎椎体间融合术对退变性腰椎滑脱合并腰椎管狭窄患者的治疗效果及术后不良事件的影响

Therapeutic effect of modified lateral lumbar interbody fusion on degenerative lumbar spondylolisthesis complicated with lumbar spinal stenosis and its influence on postoperative adverse events

摘要:

目的 探讨改良侧方入路腰椎椎体间融合术对退变性腰椎滑脱合并腰椎管狭窄患者的治疗效果及术后不良事件的影响。方法 选取2018年3月—2024年10月在山西医科大学第二医院接受治疗的286例退变性腰椎滑脱合并腰椎管狭窄患者为研究对象。通过随机数字表法将患者分为对照组和观察组，各143例。对照组接受经椎间孔腰椎椎间融合术（TLIF）治疗，观察组接受改良侧方腰椎椎间融合术（CLIF）治疗。记录患者围手术期指标，并比较两组术前和术后24 h炎症因子、应激指标水平，术后6个月评估疼痛情况和腰椎功能，并通过X射线测量椎间隙高度、椎间孔高度、腰椎前凸角（LL）、融合节段前凸角（SL）。记录硬膜囊破裂、感染、神经损伤等不良事件发生情况。结果 观察组手术时间、术中出血量和术后下床时间均低于对照组（P <0.05）。两组患者治疗前肿瘤坏死因子-α（TNF-α）、白细胞介素-6（IL-6）、IL-8比较，差异均无统计学意义（P >0.05）。观察组治疗后TNF-α、IL-6、IL-8均低于对照组（P <0.05）。观察组治疗前后TNF-α、IL-6、IL-8的差值均小于对照组（P <0.05）。两组患者治疗前促肾上腺皮质激素（ACTH）和皮质醇（Cor）比较，差异均无统计学意义（P >0.05）。观察组治疗后ACTH、Cor均低于对照组（P <0.05）。观察组治疗前后ACTH、Cor的差值均小于对照组（P <0.05）。两组患者治疗前视觉模拟评分法（VAS）评分、日本骨科协会腰椎功能评分（JOA）、Oswestry功能障碍指数（ODI）评分比较，差异均无统计学意义（P >0.05）。观察组治疗后VAS评分、ODI评分低于对照组（P <0.05），JOA评分高于对照组（P <0.05）。观察组治疗前后VAS评分、JOA评分、ODI评分的差值均大于对照组（P <0.05）。两组患者治疗前椎间隙高度、椎间孔高度、LL、SL比较，差异均无统计学意义（P >0.05）。观察组治疗后椎间隙高度、椎间孔高度、LL、SL均高于对照组（P <0.05）。观察组治疗前后椎间隙高度、椎间孔高度、LL、SL的差值均大于对照组（P <0.05）。观察组不良事件总发生率低于对照组（P <0.05）。结论 CLIF治疗腰椎滑脱合并腰椎管狭窄患者可改善术后腰椎功能，并降低不良事件发生风险。

Abstract:

Objective To investigate the therapeutic effect of modified lateral lumbar interbody fusion (crenel lateral interbody fusion, CLIF) in patients with degenerative lumbar spondylolisthesis complicated with lumbar spinal stenosis and its influence on postoperative adverse events.Methods A total of 286 patients diagnosed with degenerative lumbar spondylolisthesis and lumbar spinal stenosis who underwent treatment at our hospital between March 2018 and October 2024 were enrolled. Patients were randomly divided into a control group (n = 143) and an observation group (n = 143) using a random number table. The control group received transforaminal lumbar interbody fusion (TLIF), while the observation group underwent CLIF. Perioperative indicators were recorded. Preoperative and 24-hour postoperative levels of inflammatory cytokines and stress markers were compared between the two groups. At 6 months postoperatively, pain severity and lumbar function were assessed, and intervertebral height, foraminal height, lumbar lordosis (LL), and segmental lordosis (SL) were measured on X-ray images. Adverse events, including dural tear, infection, and nerve injury, were documented.Results The observation group had shorter operative duration, less intraoperative blood loss, and shorter postoperative ambulation time than in the control group (P < 0.05). There were no significant differences in tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), or interleukin-8 (IL-8) levels between the two groups before treatment (P > 0.05). After treatment, levels of TNF-α, IL-6, and IL-8 were significantly lower in the observation group compared with the control group (P < 0.05), and the changes in these indicators before and after treatment were also significantly smaller in the observation group (P < 0.05). Before treatment, there were no significant differences in adrenocorticotropic hormone (ACTH) and cortisol (Cor) levels between the two groups (P > 0.05). After treatment, ACTH and Cor levels were significantly lower in the observation group (P < 0.05), and the pre- to post-treatment differences were also significantly smaller in the observation group (P < 0.05). No significant differences were found between the two groups in Visual Analogue Scale (VAS) scores, Japanese Orthopaedic Association (JOA) scores, or Oswestry Disability Index (ODI) scores before treatment (P > 0.05). After treatment, VAS and ODI scores were significantly lower, while JOA scores were significantly higher, in the observation group compared with the control group (P < 0.05). The changes in VAS, JOA, and ODI scores from pre- to post-treatment were also greater in the observation group (P < 0.05). Before treatment, there were no significant differences between the two groups in intervertebral height, foraminal height, LL, or SL (P > 0.05). After treatment, all four parameters were significantly greater in the observation group than in the control group (P < 0.05), and the pre- to post-treatment differences were also greater in the observation group (P < 0.05). The overall incidence of adverse events was significantly lower in the observation group compared with the control group (P < 0.05).Conclusion CLIF improves postoperative lumbar functional recovery and reduces the risk of adverse events in patients with degenerative lumbar spondylolisthesis complicated with lumbar spinal stenosis.