Objective: To assess the clinical effect of oblique lumbar interbody fusion (OLIF) combined with posterior surgery via Wiltse approach for adult degenerative scoliosis. Methods: The clinical data of 27 patients with adult degenerative scoliosis who received OLIF operation from April 2015 to June 2018 in Tongji Hospital were analyzed retrospectively. There were 17 males and 10 females with an average age of (54±11) years. All patients were treated with OLIF combined with pedicle screw fixation via Wiltse approach. Operation time, blood loss and surgery complications were all recorded. Clinical and radiographic evaluation were investigated at 1 week, 3 months of post operation and final follow-up. Visual analog scale (VAS) for low back pain and leg pain, Oswestry disability index (ODI) for low back pain were used to evaluate the clinical efficacy of surgery. Lumbar coronal cobb angle, lumbar lordosis (LL), pelvic tilt (PT), mismatch of PI and PT, sagittal vertical axis (SVA) were investigated with full spine standing X-ray. The data were compared with factor analysis of variance. Results: All patients were followed-up for 6-52 months ((30±5) months). The operation time was (235±33) min, the blood loss was (433±62) ml. VAS for low back pain and eg pain and the ODI were significantly improved from 6.8±1.4, 7.3±1.4 and 71%±11% preoperatively to 1.1±1.2, 1.0±0.9 and 17%±6% at the latest follow-up (F=115.302,139.855,291.198, all P<0.05).Lumbar coronal Cobb angle of patients was reduced from 28°±8° preoperatively to 9°±4° at the latest follow-up (F=66.352, P<0.05). The LL was significantly increased from 20°±11° preoperatively to 33°±7° (F=17.678, P<0.05), and PT, PI-LL and SVA were significantly increased from 31°±6°,35°±12° and (90±29) mm preoperatively to 26°±5°, 21°±6° and (32±17) mm at the latest follow-up (F=6.211,23.809,53.372, all P<0.05). There was no severe vascular andnerve injuries during and after operation. Conclusion: OLIF combined with posterior surgery via Wiltse approach is a safe and effective operation in the treatment of adult degenerative scoliosis with mild to moderate sagittal imbalance, it can correct the coronal and sagittal deformity, and achieve less surgery injury, less complications and good clinical results.

目的： 观察和分析斜外侧腰椎椎间融合术（OLIF）联合后方经肌间隙入路（Wiltse入路）治疗轻、中度矢状面失平衡成人退变性脊柱侧凸的临床疗效。 方法： 回顾性分析2015年4月至2018年6月武汉同济医院接受OLIF联合后路Wiltse入路矫形内固定治疗的27例成人退变性脊柱侧凸患者的临床资料。其中男17例，女10例，年龄51~68（54±11）岁。记录患者手术时间、术中出血量、术后引流量及并发症的情况；观察术前、术后1周及术后3个月及末次随访的腰痛和腿痛的疼痛视觉模拟评分（VAS）、Oswestry功能障碍指数（ODI）以评估临床疗效；并同期行站立位脊柱全长X线片，测量和评估脊柱侧凸冠状面Cobb角、腰椎前凸角（LL）、骨盆倾斜角（PT）、骨盆入射角（PI）与LL差值（PI-LL）、矢状面垂直轴（SVA）等改变情况。手术前后各指标的比较采用单因素方差分析。 结果： 所有患者均获得随访，随访6~52（30±5）个月。手术时间为（235±33） min，术中出血量为（433±62） ml。腰痛和腿痛VAS及ODI评分分别由术前的（6.8±1.4）分、（7.3±1.4）分和71%±11%降至末次随访时的（1.1±1.2）分、（1.0±0.9）分和17%±6%，差异均有统计学意义（F=115.302、139.855、291.198，均P<0.05）。腰椎侧凸冠状面Cobb角由术前的28°±8°下降至末次随访的9°±4°（F=66.352，P<0.05）。LL由术前的20°±11°提高至末次随访时的33°±7°（F=17.678，P<0.05）。PT、PI-LL及SVA也分别下降显著，手术前后差异均有统计学意义（F=6.211、23.809、53.372，均P<0.05）。本组未出现严重的神经和血管损伤等并发症。 结论： OLIF联合Wiltse入路矫形内固定治疗轻中度矢状面失平衡成人退变性脊柱侧凸的临床疗效满意，其创伤较小、并发症少，能较好地矫正冠状面及矢状面畸形及失平衡情况。.