| 斜外侧椎间融合技术术后再手术原因与策略 |
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投稿时间：2024-03-23
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| 作者 | Author | 单位 | Address | E-Mail |
| 曾忠友 |
ZENG Zhong-you |
嘉兴市中医医院骨伤科, 浙江 嘉兴 314001 |
Department of Orthopedics, Jiaxing TCM Hospital, Jiaxing 314001, Zhejiang, China |
zjzengzy@126.com |
| 何登伟 |
HE Deng-wei |
丽水市中心医院脊柱外科, 浙江 丽水 323000 |
Department of Spine, Lishui Center Hospital, Lishui 323000, Zhejiang, China |
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| 倪文飞 |
NI Wen-fei |
温州医科大学附属第二医院脊柱外科, 浙江 温州 325027 |
Department of Spine, the Second Affiliated Hospital of Wenzhou Medical University, Wenzhou 325027, Zhejiang, China |
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| 陈平泉 |
CHEN Ping-quan |
嘉兴市中医医院骨伤科, 浙江 嘉兴 314001 |
Department of Orthopedics, Jiaxing TCM Hospital, Jiaxing 314001, Zhejiang, China |
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| 俞伟 |
YU Wei |
武警海警总队医院骨二科, 浙江 嘉兴 314000 |
The Second Department of Orthopedics, Hospital of Coast Guard General Corps of Armed Police Forces, Jiaxing 314000, Zhejiang, China |
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| 宋永兴 |
SONG Yong-xing |
嘉兴市中医医院骨伤科, 浙江 嘉兴 314001 |
Department of Orthopedics, Jiaxing TCM Hospital, Jiaxing 314001, Zhejiang, China |
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| 吴宏飞 |
WU Hong-fei |
武警海警总队医院骨二科, 浙江 嘉兴 314000 |
The Second Department of Orthopedics, Hospital of Coast Guard General Corps of Armed Police Forces, Jiaxing 314000, Zhejiang, China |
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| 范时洋 |
FAN Shi-yang |
武警海警总队医院骨二科, 浙江 嘉兴 314000 |
The Second Department of Orthopedics, Hospital of Coast Guard General Corps of Armed Police Forces, Jiaxing 314000, Zhejiang, China |
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| 宋国浩 |
SONG Guo-hao |
武警海警总队医院骨二科, 浙江 嘉兴 314000 |
The Second Department of Orthopedics, Hospital of Coast Guard General Corps of Armed Police Forces, Jiaxing 314000, Zhejiang, China |
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| 王海峰 |
WANG Hai-feng |
武警海警总队医院骨二科, 浙江 嘉兴 314000 |
The Second Department of Orthopedics, Hospital of Coast Guard General Corps of Armed Police Forces, Jiaxing 314000, Zhejiang, China |
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| 裴斐 |
PEI Fei |
武警海警总队医院骨二科, 浙江 嘉兴 314000 |
The Second Department of Orthopedics, Hospital of Coast Guard General Corps of Armed Police Forces, Jiaxing 314000, Zhejiang, China |
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| 期刊信息：《中国骨伤》2024年，第37卷，第8期，第756-764页 |
| DOI：10.12200/j.issn.1003-0034.20230338 |
| 基金项目:浙江省医药卫生科技计划项目(编号:2020KY968) |
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中文摘要:
目的：总结斜外侧椎间融合技术(oblique lateral interbody fusion,OLIF)术后再手术原因和策略,并提出预防性措施。
方法：回顾性分析自2015年10月至2019年12月采用OLIF技术治疗失败后再次手术的23例患者资料,男9例,女14例;年龄44~81(61.89±8.80)岁。疾病类型:腰椎间盘退行性病变3例,椎间盘源性腰痛1例,腰椎退行性滑脱6例,腰椎管狭窄症9例,腰椎退行性侧后凸4例。初次手术采用Stand-alone OLIF 16例,OLIF联合后路椎弓根螺钉固定7例。融合节段:单节段17例,2节段2例,3节段4例。均于初次术后3个月内接受了再次手术。再手术方法：予附加后路椎弓根螺钉内固定16例;予后路椎板间隙开窗并融合器调整神经根松解2例、内镜下关节突成形神经根松解1例、后路椎板间隙开窗神经根松解1例、椎弓根螺钉调整1例、椎间孔内镜下探查减压术1例;椎间融合器和椎弓根螺钉翻修1例。采用疼痛视觉模拟评分(visual analogue scale,VAS)和Oswestry功能障碍指数(Oswestry disability index,ODI)评价并对比再次手术前、末次随访时腰痛、腰椎功能恢复情况,随访过程中观察融合器沉降或再移位现象,以及椎间融合情况。测量并对比初次术前、初次术后、再次手术前、再次手术后3~5 d、再次手术后6个月和末次随访时椎间隙高度的变化。
结果：再次手术后患者切口皮肤无坏死、无感染。所有患者获得随访,时间12~48(28.1±7.3)个月。初次术后出现神经损伤及术后神经症状未缓解病例其神经症状于3~6个月完全缓解或恢复。随访过程中未出现椎弓根螺钉系统松动或断裂现象,融合器无进一步移位。椎间隙高度在初次术后均获得明显恢复,但出现早期的快速丢失, 经再次手术后,椎间隙高度仍有部分丢失。腰痛VAS由再次术前的(6.20±1.69)分至末次随访时的(1.60±0.71)分(P<0.05);ODI由再次术前的(40.60±7.01)%恢复至末次随访时的(9.14±2.66)%(P<0.05)。
结论：OLIF术后存在因失败而需再次手术风险,再手术原因包括患者术前存在骨量减少或骨质疏松、初次手术采用Stand-alone方式、术中的终板损伤、术中的神经损伤、术后融合器的明显沉降、术后融合器移位等。只要发现及时、处理得当,OLIF术后再手术多能获得较好的临床结果,但仍需加强预防。 |
| 【关键词】腰椎 斜外侧椎间融合 并发症 再手术 |
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| Reasons and strategies of reoperation after oblique lateral interbody fusion |
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ABSTRACT
Objective To summarize the reasons and management strategies of reoperation after oblique lateral interbody fusion (OLIF),and put forward preventive measures.
Methods From October 2015 to December 2019,23 patients who underwent reoperation after OLIF in four spine surgery centers were retrospectively analyzed. There were 9 males and 14 females with an average age of (61.89±8.80) years old ranging from 44 to 81 years old. The index diagnosis was degenerative lumbar intervertebral dics diseases in 3 cases,discogenic low back pain in 1 case,degenerative lumbar spondylolisthesis in 6 cases,lumbar spinal stenosis in 9 cases and degenerative lumbar spinal kyphoscoliosis in 4 cases. Sixteen patients were primarily treated with Stand-alone OLIF procedures and 7 cases were primarily treated with OLIF combined with posterior pedicle screw fixation. There were 17 cases of single fusion segment,2 of 2 fusion segments,4 of 3 fusion segments. All the cases underwent reoperation within 3 months after the initial surgery. The strategies of reoperation included supplementary posterior pedicle screw instrumentation in 16 cases;posterior laminectomy,cage adjustment and neurolysis in 2 cases,arthroplasty and neurolysis under endoscope in 1 case,posterior laminectomy and neurolysis in 1 case,pedicle screw adjustment in 1 case,exploration and decompression under percutaneous endoscopic in 1 case,interbody fusion cage and pedicle screw revision in 1 case. Visual analogue scale (VAS) and Oswestry disability index (ODI) index were used to evaluate and compare the recovery of low back pain and lumbar function before reoperation and at the last follow-up. During the follow-up process,the phenomenon of fusion cage settlement or re-displacement,as well as the condition of intervertebral fusion,were observed. The changes in intervertebral space height before the first operation,after the first operation,before the second operation,3 to 5 days after the second operation,6 months after the second operation,and at the latest follow-up were measured and compared.
Results There was no skin necrosis and infection. All patients were followed up from 12 to 48 months with an average of (28.1±7.3) months. Nerve root injury symptoms were relieved within 3 to 6 months. No cage transverse shifting and no dislodgement,loosening or breakage of the instrumentation was observed in any patient during the follow-up period. Though the intervertebral disc height was obviously increased at the first postoperative,there was a rapid loss in the early stage,and still partially lost after reoperation. The VAS for back pain recovered from (6.20±1.69) points preoperatively to (1.60±0.71) points postoperatively(P<0.05). The ODI recovered from (40.60±7.01)% preoperatively to (9.14±2.66)% postoperatively(P<0.05).
Conclusion There is a risk of reoperation due to failure after OLIF surgery. The reasons for reoperation include preoperative bone loss or osteoporosis the initial surgery was performed by Stand-alone,intraoperative endplate injury,significant subsidence of the fusion cage after surgery,postoperative fusion cage displacement,nerve damage,etc. As long as it is discovered in a timely manner and handled properly,further surgery after OLIF surgery can achieve better clinical results,but prevention still needs to be strengthened. Oblique lateral interbody fusion; Complications; Reoperation |
| KEY WORDS Lumbar vertebrae Oblique lateral interbody fusion Complications Reoperation |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 曾忠友,何登伟,倪文飞,陈平泉,俞伟,宋永兴,吴宏飞,范时洋,宋国浩,王海峰,裴斐.斜外侧椎间融合技术术后再手术原因与策略[J].中国骨伤,2024,37(8):756~764 |
| 英文格式: | ZENG Zhong-you,HE Deng-wei,NI Wen-fei,CHEN Ping-quan,YU Wei,SONG Yong-xing,WU Hong-fei,FAN Shi-yang,SONG Guo-hao,WANG Hai-feng,PEI Fei.Reasons and strategies of reoperation after oblique lateral interbody fusion[J].zhongguo gu shang / China J Orthop Trauma ,2024,37(8):756~764 |
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