摘要
[目的]评估极外侧入路腰椎椎间融合术(XLIF)对腰椎矢状面序列的影响。[方法]回顾2012年6月~2017年1月本科采用极外侧入路微创融合手术(XLIF)治疗的腰椎退变性疾病38例(42个节段)。观察术前及末次随访时手术间隙Cobb角、腰椎整体前凸Cobb角度、手术间隙高度(L1~S1)的变化。[结果]患者手术节段Cobb角由术前平均(11.54±7.67)°增加至末次随访时平均(12.58±8.06)°,腰椎整体前凸Cobb角由术前平均(37.42±15.25)°增加至末次随访时平均(39.46±11.86)°,但两时间点间差异无统计学意义(P>0.05);然而,手术间隙前缘高度由术前(11.26±3.95)mm显著增加至末次随访时平均(14.42±7.37)mm(P<0.05),手术间隙后缘高度由术前平均(6.37±2.46)mm显著增加至末次随访时平均(8.29±2.89)mm(P<0.05)。带角度笼架组18个节段术前手术节段Cobb角为(13.96±7.22)°,末次随访平均为(18.67±4.51)°,有明显改善(P<0.05),但不带角度笼架组24个节段手术前Cobb角与末次随访差异无统计学意义,而且两组腰椎(L1~S1)前凸Cobb角术前及末次随访差异亦无统计学意义(P>0.05)。[结论]极外侧入路腰椎椎间融合术能明显增加椎间隙高度,实现椎管的间接减压,使用带角度笼架能明显增加手术节段前凸Cobb角,但是对腰椎整体的前凸改善不明显。
[Objective] To assess the radiographic change in the sagittal plane alignment of the lumbar spine after extreme lateral interbody fusion (XLIF).[Methods] A retrospective study was done on 38 patients (42 segments) who underwent XLIF for lumbar degenerative disc disease from June 2012 to January 2017 in our department. The radiographic changes, including the local Cobb angle of the involved segment, overall Cobb angle of entire lumber spine, anterior and posterior intervertebral space heights, were assessed.[Results] The local Cobb angle in all the 38 patients increased from preoperative (11.54±7.67)° to (12.58±8.06)° at the latest follow up, while the overall Cobb angle of lumbar lordosis increased from (37.42±15.25)° to (39.46± 11.86)° correspondingly, despite of no statistically significant differences between the two time points (P>0.05). However, the anterior intervertebral space height significantly increased from (11.26±3.95) mm preoperatively to (14.42±7.37) mm at the latest follow up (P<0.05), while the posterior intervertebral space height significantly increased from (6.37±2.46) mm to (8.29± 2.89) mm correspondingly (P<0.05). The local Cobb angle in the 18 segments inserted with angled cage was of (13.96±7.22)° preoperatively, while (18.67±4.51)° at the latest follow up, which proved statistically significant (P<0.02). By contrast, the local Cobb angle in the 24 segments inserted with non-angled cage did not chang significantly before operation and at the latest follow up (P>0.05). In addition, there were no significant changes in the overall lumbar lordosis in both groups between the two time points neither (P>0.05).[Conclusion] The anterior and posterior disk heights significantly increase after XLIF, providing basis for indirect spinal decompression. The angled cages provide significant increase of local lordosis in the involved segments compared with the non-angled cages, although the overall lumbar lordosis remain unchanged.
作者
易红蕾
许俊杰
段明阳
陈兴捷
吴增晖
YI Hong-lei;XU Jun-jie;DUAN Ming-yang;CHEN Xing-jie;WU Zeng-hui(Orthopaedic Department,General Hospital of Southern Theater of PLA,Guangzhou510000 ,China)
出处
《中国矫形外科杂志》
CAS
CSCD
北大核心
2019年第19期1754-1758,共5页
Orthopedic Journal of China
基金
广州市珠江科技新星人才项目(编号：201610010135)
关键词
极外侧入路腰椎融合术
腰椎前凸
矢状面对线
extreme lateral interbody fusion (XLIF)
lumbar lordosis
sagittal alignment
