斜外侧腰椎间融合术治疗退变性腰椎疾病的并发症和早期临床结果

Early clinical results and complications of oblique lumbar interbody fusion for degenerative lumbar diseases

中文关键词:  斜外侧腰椎间融合术  并发症  微创外科  退变性腰椎疾病

英文关键词:Oblique lumbar interbody fusion  Complications  Minimallyinvasive surgery  Degenerative lumbar diseases

中文摘要:

  【摘要】 目的：基于斜外侧腰椎间融合术（oblique lumbar interbody fusion，OLIF）治疗退变性腰椎疾病围手术期和随访资料，探讨其并发症情况和早期临床结果。方法：回顾性研究2014年11月～2017年2月间行OLIF手术治疗的86例腰椎退变性疾病患者临床资料，男38例，女48例，平均年龄52.6±6.1岁（42~70岁）。病例诊断包括：腰椎滑脱41例（47.7%）、腰椎不稳14例（16.3%），椎间盘源性腰痛14例（16.3%）、腰椎融合术后邻椎病10例（11.6%），成年腰椎侧凸7例（8.1%）。61例（70.9%）患者接受OLIF和经皮椎弓根螺钉固定，25例（29.1%）行单纯OLIF。行单节段OLIF者79例，两节段OLIF者5例，三节段OLIF者2例。收集患者临床资料（术中参数仅包括OLIF相关内容），分析并发症发生情况和早期临床结果。分析骨质疏松对椎体终板骨折和融合器下沉的影响，以及单纯OLIF或辅助椎弓根螺钉固定对融合器下沉和椎间融合的作用。结果：平均手术时间为41.7±11.3min，平均术中出血为20.5±14.3ml。并发症包括供骨区疼痛17例（19.8%）、大腿麻木/疼痛11例（12.8%）、终板骨折10例（11.6%）、髂腰肌/股四头肌乏力4例（4.7%）、交感神经损伤2例（2.3%）、麻痹性肠梗阻1例（1.2%）和椎间隙感染1例（1.2%）。无永久性神经损伤后遗症。86例术后随访6个月以上，平均随访13.4±4.8个月。末次随访时腰痛VAS评分由术前6.1±2.5分下降为1.3±0.8分（P=0.003）。ODI由术前（32.6±10.1）％下降为（14.2±4.5）％（P=0.004）。86例总融合率为91.9%（79/86）。重度骨质疏松显著增加椎体终板骨折风险（P=0.003），骨质疏松显著增加末次随访时融合器下沉发生率（P=0.000）。单纯OLIF或辅助椎弓根螺钉固定对融合器下沉和椎间融合无显著作用（P＞0.05）。结论：OLIF治疗腰椎退变性疾病有适应证限制，可获得良好的早期临床结果，同时存在腰椎前路手术相关并发症风险，腰椎骨质疏松可显著增加并发症发生率。

英文摘要:

  【Abstract】 Objectives: To investigate the early clinical results and complications associated with degenerative lumbar diseases treated by performing oblique lumbar interbody fusion(OLIF) based on the perioperative parameters and follow-up data. Methods: From November 2014 to February 2017, total 86 consecutive patients undergoing OLIF were retrospective analyzed. There were 38 males and 48 females with an average age of 52.6±6.1 years(42-70 years). The diagnosis included lumbar spondylolisthesis in 41 cases, lumbar instability in 14 cases, discogenic low back pain in 14 cases, adjacent segmental disease after posterior lumbar fusion in 10 cases, and adult lumbar scoliosis in 7 cases. Sixty one patients underwent OLIF with bilateral percutaneous pedicle screw fixation. Twenty five received stand-alone OLIF. Single-level OLIF was performed in 79 cases, two-level OLIF in 5 cases, three-level OLIF in 2 cases. All intraoperative parameters such as operation time and estimated blood loss, and intra/postoperative complications only included the measurement and findings related to the OLIF procedure. The early clinical results and complications were assessed and analyzed based on the clinical data related to the OLIF procedure. The influences of vertebral osteoporosis on endplate fractures and cage subsidence, and the effect of stand-alone OLIF or combined with percutaneous pedicle screw fixation on cage subsidence and interbody fusion were analyzed, respectively. Results: The mean operation time was 41.7±11.3min. The average blood loss was 20.5±14.3ml. The complications included donor site pain in 17 cases(19.8%), thigh numbness/pain in 11 cases(12.8%), end-plate fracture in 10 cases(11.6%), psoas/quadriceps weakness in 4 cases(4.7%), sympathetic nerve injury in 2 cases(2.3%), paralytic ileus in 1 case(1.2%) and intervertebral infection in 1 case(1.2%). No permanent neurological sequelae were observed in these series. Eighty six patients achieved more than six months follow-up, and the average follow-up period was 13.4±4.8 months. The back pain VAS scores and ODI decreased respectively from 6.1±2.5 before surgery to 1.3±0.8 at final follow-up(P=0.003) and from (32.6±10.1)% before surgery to (14.2±4.5)% at final follow-up(P=0.004). Total fusion rate was 91.9%(79/86) at final follow-up. Compared to patients without osteoporosis, severe vertebral osteoporosis significantly increased vertebral endplate fracture risk(P=0.003), and significantly increased cage subsidence at final follow-up. Stand-alone OLIF or combined with percutaneous pedicle screw fixation had no significant effect on cage subsidence and interbody fusion(P=0.199). Conclusions: The indications of OLIF for degenerative lumbar diseases are limited, this technique may obtain good early clinical outcomes and suffer from complication risk related with anterior lumbar surgery. Lumbar osteoporosis may significantly increase complication rates during procedures.