摘要
目的 探讨经前外侧入路腰椎融合术(oblique lumbar interbody fusion, OLIF)一期联合前外侧钉棒系统内固定治疗腰椎退变性疾病的疗效。方法 2018年2月~2020年3月我科采用OLIF一期联合前外侧钉棒系统内固定治疗76例腰椎退变性疾病,从前外侧入路钝性分离三层腹肌,并在腰大肌前间隙显露椎间隙,一期植入融合器及单侧螺钉及复位棒。比较术前与术后1周椎间隙高度、双侧椎间孔高度、椎管横截面面积,术前与术后1周、末次随访腰、腿痛视觉模拟评分(Visual Analogue Scale, VAS)及Oswestry功能障碍指数(Oswestry Disability Index, ODI)。结果 并发症发生率26.3%(20/76):术中4例节段动脉损伤出血,经过压迫止血及使用止血材料后出血停止;术后4例大腿前方疼痛,4例交感神经链损伤,对症及营养神经等治疗症状1~3个月后均缓解;8例融合器下沉,延长卧床休息时间等治疗,术后复查亦稳定融合。术后1周椎间隙高度(1.1±0.2)cm,明显高于术前(0.7±0.2)cm(t=-11.654,P=0.000);术后1周椎间孔高度左侧(2.1±0.2)cm,右侧(2.0±0.3)cm,均明显高于术前左侧(1.7±0.2)cm和右侧(1.6±0.3)cm(t=-13.748,P=0.000;t=-9.688,P=0.000);术后1周椎管横截面面积(1.4±0.2)cm^(2),明显大于术前(0.9±0.3)cm^(2)(t=-16.317,P=0.000)。术后1周和末次随访腰、腿疼痛VAS评分和ODI较术前明显降低(均P=0.000)。结论 OLIF一期联合前外侧钉棒系统内固定治疗腰椎退变性疾病,置钉固定安全高效,骨融合率高,为腰椎退变的微创治疗提供一种新的选择。
Objective To investigate the clinical efficacy of one-stage oblique lumbar interbody fusion(OLIF) combined with anterolateral screw-rod system internal fixation in the treatment of lumbar degenerative diseases. Methods The related data of 76 patients with lumbar degenerative diseases treated by one-stage OLIF combined with anterolateral screw-rod internal fixation in our department from February 2018 to March 2020 were analyzed retrospectively. The anterior lateral approach was used to bluntly separate the three-layer abdominal muscles, expose the intervertebral space in the anterior space of the psoas major muscle, and implant the fusion cage, unilateral screw, and reduction rod in one session. The height of intervertebral space, bilateral intervertebral foramen, cross-sectional area of spinal canal, Visual Analogue Scale(VAS), and Oswestry Dysfunction Index(ODI) were compared before and 1 week after operation. Results The one-stage OLIF combined with anterolateral screw-rod internal fixation was smoothly accomplished in all the 76 cases. The operation time was(75.0±33.4) min, and the intraoperative blood loss was(49.6±20.8) ml. The incidence of complications was 26.3%(20/76). There were 4 cases of segmenting artery injury and bleeding during operation, and the bleeding was stopped after compression hemostasis by using hemostatic materials. There were 4 cases of anterior thigh pain and 4 cases of sympathetic nerve chain injury after operation. Their symptoms were relieved after 1-3 months of symptomatic and nutritional nerve treatment. There were 8 cases of fusion cage sinking, who were given prolonged bed rest and other treatment until stable fusion confirmed by postoperative re-examinations.The disc height at 1 week after surgery was(1.1±0.2) cm, which was significantly higher than that before surgery [(0.7±0.2) cm, t=-11.654, P=0.000]. At one week after surgery, the foraminal heights of left side [(2.1±0.2) cm] and right risde [(2.0±0.3) cm] were significantly higher than those of preoperation [left:(1.7±0.2) cm, t=-13.748, P=0.000;right:(1.6±0.3) cm, t=-9.688, P=0.000]. The cross-sectional area of the spinal canal at 1 week after surgery was(1.4±0.2) cm^(2), which was significantly larger than that before surgery [(0.9±0.3) cm^(2), t=-16.317, P=0.000]. The VAS score of lumbar and leg pain and ODI at 1 week after operation and the last follow-up significantly decreased as compared to the preoperative results(all P=0.000). Conclusions The one-stage OLIF combined with anterolateral screw-rod internal fixation in the treatment of lumbar degenerative diseases is safe and efficient, with a high bone fusion rate. It can provide a new choice for minimally invasive treatment of lumbar degenerative diseases.
作者
白亮
陈勇
李伟
张雷
赵耀伟
曾庆亮
庄全魁
Bai Liang;Chen Yong;Li Wei(Department of Orthopedics,Fuyang Second People’s Hospital,Fuyang 236000,China)
出处
《中国微创外科杂志》
CSCD
北大核心
2023年第2期118-123,共6页
Chinese Journal of Minimally Invasive Surgery
关键词
前外侧入路腰椎融合术
腰椎退变性疾病
钉棒系统
Oblique lumbar interbody fusion
Degenerative disease of lumbar spine
Screw-rod system
