| 微创腰椎斜前方椎间融合术治疗退变性腰椎疾病的中早期疗效和并发症分析 |
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Received:January 20, 2021
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| 作者 | Author | 单位 | Unit | E-Mail |
| 赵永生 |
ZHAO Yong-sheng |
青岛市市立医院本部脊柱外科, 山东 青岛 266000 |
Department of Spinal Surgery, Qingdao Municipal Hospital, Qingdao 266000, Shandong, China |
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| 李强 |
LI Qiang |
青岛市市立医院本部脊柱外科, 山东 青岛 266000 |
Department of Spinal Surgery, Qingdao Municipal Hospital, Qingdao 266000, Shandong, China |
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| 王洋 |
WANG Yang |
青岛市市立医院本部脊柱外科, 山东 青岛 266000 |
Department of Spinal Surgery, Qingdao Municipal Hospital, Qingdao 266000, Shandong, China |
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| 张承韶 |
and ZHANG Cheng-shao |
青岛市市立医院本部脊柱外科, 山东 青岛 266000 |
Department of Spinal Surgery, Qingdao Municipal Hospital, Qingdao 266000, Shandong, China |
zh-ys@163.com |
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| 期刊信息：《中国骨伤》2022年35卷，第2期，第142-147页 |
| DOI：10.12200/j.issn.1003-0034.2022.02.010 |
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目的：探讨微创经腹膜外斜前方入路椎体间融合术（oblique lumbar interbody fusion，OLIF）治疗退变性腰椎疾病的中早期疗效并分析其并发症。
方法：回顾性分析2017年10月至2019年3月以OLIF术式治疗的退变性腰椎疾病患者22例，男14例，女8例，年龄51~72（63.15±7.22）岁，其中腰椎管狭窄6例，腰椎滑脱5例，邻椎病4例，退变性腰椎侧弯3例，椎间盘源性腰痛3例，腰椎后路减压术复发1例。后路微创椎弓根钉固定13例，无后路固定（Stand-alone）9例。记录术中出血量、手术时间、术后引流量、下地时间，测量椎间隙高度、椎间孔高度、椎间孔面积、椎管直径、椎管面积，观察椎间融合情况、椎间融合器沉降等影像学变化及并发症等，比较术前及术后3，6，12个月Oswestry功能障碍指数（Oswestry Disability Index，ODI），疼痛数字评分（numeric rating scales，NRS），日本骨科协会（Japanese Orthopaedic Association，JOA）评分。
结果：22例患者均顺利完成手术，术中出血量25~280（95.45±79.07）ml，单纯前路术中出血量25~70（45.71±15.42）ml；手术时间75~210（137.72±37.66）min，单纯前路手术时间75~105（91.40±15.96）min。术后拔管前总引流量10~110（56.23±31.15）ml，下地时间为术后24~72（54.48±18.24）h。术后椎间隙高度较术前增加（6.63±2.61）mm（P<0.05）；术后椎间孔高度较术前增加（5.35±2.47）mm（P<0.05）；术后椎间孔面积较术前增加（97.67±33.58）mm2（P<0.05）；术后椎管直径较术前增加（3.31±1.61）mm（P<0.05）；术后椎管面积较术前增加（57.52±31.39）mm2（P<0.05）。术后6个月5例患者椎间融合，术后12个月22例均达到椎间骨性融合。5例患者出现融合器沉降，均为未行后路固定的病例。未出现大血管、输尿管、硬膜囊、神经根损伤等严重并发症；发生腹膜损伤1例，术后一过性大腿疼痛、股四头肌肌力下降4例，交感神经损伤1例。术后3 d腰痛及下肢根性痛等症状均明显缓解，术后6个月及12个月的ODI、NRS及JOA评分较术前明显改善（P<0.05）。
结论：OLIF术式治疗指征明确的腰椎退变性疾病可取得满意临床效果，术中出血少、下地时间早、并发症少，可明显改善椎间孔高度和椎管面积，间接减压神经根，术后融合率高。但早期开展手术时间较长，并且可能发生腹膜损伤、腰丛过度牵拉等并发症，Stand-alone技术融合器沉降发生率较高。 |
| [关键词]:退变性腰椎疾病 脊柱融合术 微创外科手术 |
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| Analysis of early and middle stage efficacy and complications of oblique lumbar interbody fusion in treating degenerative lumbar diseases |
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Abstract:
Objective: To investigate the early and middle stage efficacy and complications of minimally invasive extraperitoneal oblique lumbar interbody fusion (OLIF) in the treatment of degenerative lumbar diseases.
Methods: The clinical data of 22 patients with degenerative lumbar diseases underwent OLIF from October 2017 to March 2019 were retrospectively analyzed,including 14 males and 8 females,aged from 51 to 72 years with an average of (63.15±7.22) years. There were 6 cases of lumbar spinal stenosis,5 cases of lumbar spondylolisthesis,4 cases of adjacent vertebral disease,3 cases of degenerative lumbar scoliosis,3 cases of discogenic low back pain,and 1 case of recurrence after posterior lumbar decompression. Posterior minimally invasive pedicle screw fixation was performed in 13 cases and Stand-alone fixation in 9 cases. Intraoperative blood loss,operation time,postoperative drainage volume,landing time were recorded. The intervertebral disc height(IDH),intervertebral foramen height(IFH),intervertebral foramen area(IFA),canal diameter(CD),canal area(CA) were measured before and after operation. The imaging changes (including location of fusion cage,interbody fusion,and cage subsidence) and complications were observed. Oswestry Disability Index (ODI),numerical rating scales (NRS) and Japanese Orthopaedic Association (JOA) scores were compared before and 3,6,12 months after operation.
Results: All 22 patients successfully completed the operation. The intraoperative blood loss was 25 to 280 ml with an average of (95.45±79.07) ml and that of simple anterior approach was 25 to 70 ml with an average of (45.71±15.42) ml. The operation time was 75 to 210 min with an average of (137.72±37.66) min,and the simple anterior operation time was 75 to 105 min with an average of (91.40±15.96) min. The total drainage volume was 10 to 110 ml with an average of (56.23±31.15) ml,and the time to go down to the ground was 24 to 72 hours (54.48±18.24) hours after operation. Postoperative IDH improved (6.63±2.61)mm(P<0.05),the IFH improved (5.35±2.47)mm (P<0.05),the IFA improved (97.67±33.58)mm2(P<0.05),the CD improved (3.31±1.61) mm(P<0.05),the CA improved (57.52±31.39) mm2(P<0.05). Five patients got interbody fusion at 6 months after operation and all 22 patients got interbody fusion at 12 months after operation. There was 5 cases of fusion cage subsidence,all of which occurred in the cases without posterior fixation(using Stand-alone fixation). There was no serious complication such as big blood vessel injury,ureter injury,dural sac injury and nerve root injury. Peritoneal injury occurred in 1 case,postoperative transient thigh pain,decrease of quadriceps femoris muscle strength in 4 cases and sympathetic nerve injury in 1 case. The symptoms of lumbago and radicular pain of lower extremities were alleviated obviously 3 days after operation. The ODI,NRS and JOA scores at 6,12 months after operation were significantly improved(P<0.05).
Conclusion: The treatment of lumbar degenerative diseases with definite indications by OLIF can achieve satisfactory clinical results,and it has advantages of less intraoperative bleeding,fast time to land,less complications,good imaging improvement and indirect decompression. But the operation time and fluoroscopy time are longer in the early stage,and complications such as peritoneal injury and lumbar plexus over traction may occur. The long-term incidence of settlement of fusion cage with Stand-alone technology is higher. |
| KEYWORDS:Degenerative lumbar disease Spinal fusion Minimal surgical procedures |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 赵永生,李强,王洋,张承韶.微创腰椎斜前方椎间融合术治疗退变性腰椎疾病的中早期疗效和并发症分析[J].中国骨伤,2022,35(2):142~147 |
| 英文格式: | ZHAO Yong-sheng,LI Qiang,WANG Yang,and ZHANG Cheng-shao.Analysis of early and middle stage efficacy and complications of oblique lumbar interbody fusion in treating degenerative lumbar diseases[J].zhongguo gu shang / China J Orthop Trauma ,2022,35(2):142~147 |
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