Objective: To observe the difference between crenel lateral interbody fusion (CLIF) and transforaminal lumbar interbody fusion (TLIF) in the treatment of degenerative lumbar spondylolisthesis (DLS) combined with lumbar spinal stenosis (LSS).
Methods: The clinical data of DLS combined with LSS patients meeting the selection criteria admitted between May 2018 and May 2019 were retrospectively analyzed. According to different surgical methods, the patients were divided into CLIF group (33 cases) and TLIF group (32 cases). There were no significant differences ( P>0.05) between the two groups in gender, age, disease duration, lesion segments, lumbar bone mineral density, degree of lumbar spondylolisthesis, and preoperative visual analogue scale (VAS) score, Oswestry disability index (ODI), intervertebral space height, intervertebral foramen height, lumbar lordosis (LL), and segmental lordosis (SL). The operation time, intraoperative blood loss, and perioperative complications were recorded and compared between the two groups. Lumbar CT scan was performed at last follow-up to compare the intervertebral fusion rate between the two groups. Intervertebral space height, intervertebral foramen height, LL, and SL were measured before operation, at 2 weeks, 3 months after operation, and at last follow-up. VAS score and ODI were used to evaluate the pain and improvement of the quality of life of the patients.
Results: There were no neurological and vascular complications in the two groups. The operation time and intraoperative blood loss in CLIF group were significantly less than those in TLIF group ( P<0.05). Patients in both groups were followed up for a median time of 18 months. All the incisions healed by first intention except 1 incision in TLIF group because of poor blood glucose control. No complications such as bedsore, falling pneumonia, and deep venous thrombosis were found in both groups. At last follow-up, the intervertebral fusion rates in CLIF and TLIF group were 90.91% (30/33) and 93.75% (30/32), respectively, showing no significant difference ( χ 2=0.185, P=0.667). The VAS score, ODI, intervertebral space height, intervertebral foramen height, LL, and SL were significantly improved in both groups at each time point after operation ( P<0.05). Except that VAS score in CLIF group was significantly lower than that in TLIF group at 2 weeks after operation ( Z=-4.303, P=0.000), there were no significant differences in VAS score and ODI between the two groups at other time points ( P>0.05). The intervertebral space height, intervertebral foramen height, LL, and SL in CLIF group were significantly higher than those in TLIF group at each time point after operation, and the differences were significant ( P<0.05).
Conclusion: CLIF in the treatment of DLS combined with LSS can achieve the similar effectiveness with traditional TLIF, and has such advantages as minimal invasion and faster recovery.
目的: 比较改良侧方腰椎椎间融合术（crenel lateral interbody fusion，CLIF）与经椎间孔腰椎椎间融合术（transforaminal lumbar interbody fusion，TLIF）治疗退变性腰椎滑脱（degenerative lumbar spondylolisthesis，DLS）合并腰椎管狭窄症（lumbar spinal stenosis，LSS）的疗效。.
方法: 回顾分析 2018 年 5 月—2019 年 5 月收治并符合选择标准的 DLS 合并 LSS 患者临床资料。根据手术方式分为 CLIF 组 33 例及 TLIF 组 32 例。两组患者性别、年龄、病程、病变节段、腰椎骨密度、腰椎滑脱程度及术前疼痛视觉模拟评分（VAS）、Oswestry 功能障碍指数（ODI）、椎间隙高度、椎间孔高度、腰椎前凸角（lumbar lordosis，LL）、融合节段前凸角（segmental lordosis，SL）等一般资料比较，差异均无统计学意义（ P>0.05）。记录并比较两组患者手术时间、术中出血量、围术期并发症发生情况；末次随访时行腰椎 CT 检查，比较两组椎间融合率；术前及术后 2 周、3 个月、末次随访时测量椎间隙高度、椎间孔高度、LL、SL，采用 VAS 评分、ODI 评估患者疼痛及生活质量改善情况。.
结果: 两组患者术中未出现神经及血管损伤相关并发症。CLIF 组手术时间及术中出血量均显著少于 TLIF 组（ P<0.05）。两组患者均获随访，随访时间中位数均为 18 个月。除 TLIF 组术后 1 例因血糖控制不佳手术切口愈合不良外，两组其余患者手术切口均Ⅰ期愈合。两组均未出现褥疮、坠积性肺炎及下肢深静脉血栓形成等并发症。末次随访时，CLIF 组和 TLIF 组椎间融合率分别为 90.91%（30/33）和 93.75%（30/32），差异无统计学意义（ χ 2=0.185， P=0.667）。两组术后各时间点 VAS 评分、ODI、椎间隙高度、椎间孔高度、LL 及 SL 均较术前显著改善（ P<0.05）。除术后 2 周 CLIF 组 VAS 评分低于 TLIF 组，差异有统计学意义（ Z=−4.303， P=0.000）外，其余各时间点两组间 VAS 评分及 ODI 比较差异均无统计学意义（ P>0.05）；术后各时间点 CLIF 组椎间隙高度、椎间孔高度、LL 及 SL 均显著大于 TLIF 组，差异有统计学意义（ P<0.05）。.
结论: 采用 CLIF 手术治疗 DLS 合并 LSS 可取得与传统 TLIF 相同的治疗效果，还具有创伤小、术后恢复快等优点。.
Keywords: Degenerative lumbar spondylolisthesis; crenel lateral interbody fusion; lumbar spinal stenosis; transforaminal lumbar interbody fusion.