摘要
目的:探讨Stand-alone斜外侧椎间融合(oblique lateral interbody fusion,OLIF)应用于Modic改变伴终板硬化的腰椎间盘退变治疗的可行性和临床效果。方法:回顾性分析2015年1月至2018年12月3家医疗中心收治的16例Modic改变伴终板硬化的腰椎间盘退变患者。其中男6例,女10例;年龄45~67(55.48±8.07)岁;病史36~240(82.40±47.68)个月。病变部位:L2,32例,L3,45例,L4,59例;均表现为慢性腰痛,伴下肢神经症状3例。采用单纯斜外侧腰椎椎间融合术治疗,术后对临床和影像学结果,以及并发症情况进行观察。结果:术中无血管、终板损伤和椎体骨折。切口长度(4.06±0.42)cm,手术时间(45.12±5.43)min,术中出血量(33.40±7.29)ml;术后72 h切口疼痛视觉模拟评分(visual analogue scale,VAS)为1.14±0.47。所有患者无切口皮肤坏死、愈合不良或感染;出现交感链损伤1例、左大腿前外侧疼痛并麻木2例、左侧髂腰肌无力1例,均为一过性损伤,并发症发生率为25%(4/16)。16例患者均获得随访,时间12~36(20.80±5.46)个月。术后椎间隙高度获得明显的恢复,随访过程中有轻度丢失。末次随访时腰椎冠状面和矢状面平衡均获得良好的改善。融合器无明显沉降或移位,均获得椎间融合。末次随访时日本骨科协会(Japanese Orthop-aedic Association,JOA)评分和Oswestry功能障碍指数(Oswestry disability index,ODI)明显改善。结论:只要严格病例选择,充分的术前检查,采用Stand-alone OLIF治疗Modic改变伴终板硬化的腰椎间盘退变效果良好,临床优势明显,是较好的手术选择。
Objective To explore the feasibility and clinical effect of Stand-alone oblique lateral interbody fusion(OLIF)in the treatment of lumbar intervertebral disc degeneration with Modic changes and endplate sclerosis.Methods A retrospective analysis was performed on 16 cases with lumbar intervertebral disc degeneration with Modic changes and endplate sclerosis admitted to three medical centers from January 2015 to December 2018.There were 6 males and 10 females,the age ranged from 45 to 67 years old with an average of(55.48±8.07)years old,the medical history ranged from 36 to 240 months with an average of(82.40±47.68)months.The lesion sites included L2,3 in 2 cases,L3,4 in 5 cases,and L4,5 in 9 cases.All patients presented with chronic low back pain with lower limb neurological symptoms in 3 cases.All patients were treated by Stand-alone oblique lateral lumbar interbody fusion.Clinical and radiological findings and complications were observed.Results There was no vascular injury,endplate injury and vertebral fracture during the operation.The mean incision length,operation time,and intraoperative blood loss were(4.06±0.42)cm,(45.12±5.43)min,(33.40±7.29)ml,respectively.The mean visual analogue scale(VAS)of the incision pain was(1.14±0.47)at 72 hours after operation.There was no incision skin necrosis,poor incision healing or infection in patients.Sympathetic chain injury occurred in 1 case,anterolateral pain and numbness of the left thigh in 2 cases,and weakness of the left iliopsoas muscle in 1 case,all of which were transient injuries with a complication rate of 25%(4/16).All 16 patients were followed up from 12 to 36 months with an average of(20.80±5.46)months.The intervertebral space height was significantly recovered after operation,with slight lost during the follow-up.Coronal and sagittal balance of the lumbar spine showed good improvement at the final follow-up.There was no obvious subsidence or displacement of the cage,and the interbody fusion was obtained.At the final follow-up,Japanese Orthopaedic Asso
作者
陈平泉
曾忠友
赵兴
范时洋
吴宏飞
俞伟
张建乔
宋永兴
范顺武
方向前
裴斐
宋国浩
CHEN Ping-quan;ZENG Zhong-you;ZHAO Xing;FAN Shi-yang;WU Hong-fei;YU Wei;ZHANG Jian-qiao;SONG Yong-xing;FAN Shun-wu;FANG Xiang-qian;PEI Fei;SONG Guo-hao(Department of Orthopaedics,Jiaxing TCM Hospital,Jiaxing314001,Zhejing,China;The Second Department of Orthopaedics,Armed Police Marine Police Corps Hospital,Orthopedic Medical Center of Armed Police Force,Jiaxing314000,Zhejiang,China;Department of Orthopaedics,Run Run Show Hospital Affiliated to Zhejiang University Medical School,Hangzhou 310016,Zhejiang,China)
出处
《中国骨伤》
CAS
CSCD
2023年第1期29-37,共9页
China Journal of Orthopaedics and Traumatology
基金
浙江省医药卫生科技计划项目(编号:2020KY968)。
