摘要
目的探讨斜外侧椎间融合(oblique lateral interbody fusion,OLIF)治疗腰椎固定融合术后邻近节段疾病(adjacent segment disease,ASDis)的可行性及临床疗效。方法回顾性分析四家医院2015年6月至2018年12月采用OLIF治疗的31例ASDis的患者资料,男17例、女14例,年龄(65.7±3.4)岁(范围59~75岁)。既往行单节段固定融合19例,双节段固定融合11例,三节段固定融合1例;原固定融合部位:L1,21例、L3,43例、L4,511例、L5S14例、L3~L56例、L4~S15例、L3~S11例;初次固定融合术至入院时间为(82.5±45.5)个月(范围24~180个月)。ASDis发生于固定融合节段近端28例,发生于远端3例。ASDis类型:腰椎间盘退行性病变11例,腰椎管狭窄症15例,腰椎退行性滑脱2例,退行性侧后凸畸形3例。ASDis发生部位:L2,36例、L3,412例、L4,56例、L1~L33例、L2~L41例、L1~L43例。入院时腰椎内固定已取出3例,存留28例。采用Stand-alone OLIF 19例、OLIF联合椎弓根螺钉固定8例、OLIF联合皮质骨螺钉固定4例。采用视觉模拟评分(visual analogue scale,VAS)和Oswestry功能障碍指数(Oswestry disability index,ODI)评价术前和末次随访时的腰痛和腰椎功能,观察影像结果和并发症。结果31例随访时间(23.6±9.6)个月(范围12~60个月);手术时间(73.8±25.3)min(范围40~180min);术中出血量(86.2±67.4)ml(范围20~310ml),每个节段平均出血量24.8 ml。术中出现节段静脉损伤1例、终板损伤7例,术后出现一过性髂腰肌无力2例、大腿疼痛麻木1例、不全性肠梗阻1例,无一例出现切口皮肤坏死和感染等并发症。腰痛VAS评分由术前(5.9±1.9)分降至末次随访时的(1.4±0.6)分,差异有统计学意义(t=8.47,P<0.001);ODI指数由术前的45.2%±5.7%降低至末次随访时的13.8%±4.7%,差异有统计学意义(t=7.92,P<0.001)。椎间隙高度由术前的(8.7±1.6)mm增加至术后的(11.4±1.9)mm及末次随访时的(9.9±1.8)mm,手术前后比较差异有统计学意义(F=4.15,P=0.007),末次随访
Objective To explore the feasibility and clinical efficacy of oblique lateral interbody fusion(OLIF)in the treatment of adjacent segment disease(ASDis).Methods Retrospective analysis was conducted on the data of 31 patients with ASDis treated by OLIF in four medical centers from June 2015 to December 2018.There were 17 males and 14 females.The average age was(65.7±3.4)years(range,59 to 75 years).19 cases received single-segment fixed fusion,11 cases received double-segment fixed fusion and 1 case received three-segment fixed fusion.Original fixed fusion site:1 case of L1,2,3 cases of L3,4,11 cases of L4,5,4 cases of L5S1,6 cases of L3-L5,5 cases of L4-S1,and 1 case of L3-S1.The time from the initial fixation and fusion to this admission was 82.5±45.5 months(rang,24 to 180 months).ASDis occurred at the proximal end of the fixed fusion segment in 28 cases and at the distal end in 3 cases.The types of ASDis:degenerative disc disease in 11 cases,lumbar spinal stenosis in 15 cases,degenerative spondylolisthesis in 2 cases,and degenerative scoliosis in 3 cases.The location of ASDis:6 cases of L2,3,12 cases of L3,4,6 cases of L4,5,3 cases of L1-L3,1 case of L2-L4,and 3 cases of L1-L4.At admission,3 cases of lumbar internal fixation had been removed and 28 cases of internal fixation remained.Stand-alone OLIF was performed in 19 cases,OLIF combined with pedicle screw fixation in 8 cases,and OLIF combined with cortical screw fixation in 4 cases.Visual analogue scale(VAS)and Oswestry disability index(ODI)were used to evaluate the low back pain and lumbar function before operation and at the last follow-up,and the imaging results and complications were observed.Results All patients were followed up.The follow-up time was 23.6±9.6 months(range,12 to 60 months).The operation time was 73.8±25.3 mins(range,40 to 180 min),and the intraoperative blood loss was 86.2±67.4 ml(range,20 to 310 ml).The average blood loss in each segment was 24.8 ml.During the operation,there were 1 case of segmental vein injury,7 cases of endplate
作者
曾忠友
赵兴
王建
陈平泉
俞伟
吴宏飞
宋永兴
范顺武
方向前
裴斐
范时洋
宋国浩
Zeng Zhongyou;Zhao Xing;Wang Jian;Chen Pingquan;Yu Wei;Wu Hongfei;Song Yongxing;Fan Shunwu;Fang Xiangqian;Pei Fei;Fan Shiyang;Song Guohao(The Second Department of Orthopaedics,Hospital of Coast Guard General Corps of Armed Police Forces,Jiaxing 314000,China;Department of Orthopaedics,Sir Run Run Shaw Hospital of Medical College of Zhejiang University,Hangzhou 310016,China;Department of Orthopaedics,Second Affiliated Hospital of Army Medical University,Chongqing 400037,China;Department of Orthopedics,Jiaxing Hospital of Traditional Chinese Medicine,Jiaxing 314001,China)
出处
《中华骨科杂志》
CAS
CSCD
北大核心
2022年第24期1643-1651,共9页
Chinese Journal of Orthopaedics
基金
浙江省医药卫生科技计划项目(2020KY968)。
关键词
腰椎
内固定器
脊柱融合术
邻椎病
Lumbar vertebra
Internal Fixators
Spinal fusion
Adjacent segment disease
