斜外侧腰椎椎间融合术治疗退行性腰椎疾病的并发症及其防治策略

Complications and prevention strategies of oblique lateral interbody fusion in the treatment of degenerative lumbar disease

中文关键词:  斜外侧腰椎椎间融合术  退行性腰椎疾病  并发症  防治策略

英文关键词:Oblique lateral interbody fusion  Degenerative lumbar disease  Complications  Interventions

中文摘要:

  【摘要】 目的：总结斜外侧腰椎椎间融合术（oblique lateral interbody fusion，OLIF）治疗退行性腰椎疾病的并发症及防治策略。方法：回顾性分析我院2016年7月~2018年2月采用OLIF治疗的退行性腰椎疾病患者共78例，男37例，女41例，年龄45~78岁，平均54.2±7.9岁，随访13~36个月，平均18.3±4.1个月。其中退行性腰椎管狭窄症25例（32.1%），退行性腰椎侧凸23例（29.5%），退行性腰椎滑脱18例（23.1%），椎间盘源性腰痛12例（15.4%）。手术节段L2/3 31例，L3/4 47例，L4/5 37例；单节段融合52例，双节段融合15例，三节段融合11例。其中6例一期或二期行后路椎弓根钉棒内固定术，72例未行后路椎弓根钉棒内固定术。统计手术时间、出血量、术中与术后并发症发生情况等。结果：所有患者均顺利完成手术，手术时间45～351min，平均130±55min。术中出血量为50～2500ml，平均为118±76ml。共有18例（23.1%）患者出现并发症，其中术中并发症5例，包括终板损伤2例，术中一期给予后路钉棒内固定处理，至末次随访时未出现其他并发症；节段动脉损伤1例，术中给予结扎止血，术后未出现进一步失血；左髂总静脉损伤1例，术中予修补、止血材料止血及输血，术后患者出现下肢肿胀，抬高患肢、抗凝等处理后肿胀消退；腹膜损伤1例，术中予腹膜修补，术后次日患者肠道功能恢复。出现术后并发症13例，包括融合器沉降2例，融合器移位2例，均二期及时给予后路钉棒内固定治疗；大腿前方麻木3例，术后予神经营养药治疗，1周左右患者麻木症状明显改善；下肢皮温感觉异常2例，予营养神经治疗，随访4个月时患者症状恢复；假关节形成2例，但无临床症状，未予特殊处理；术后不完全性肠梗阻1例，禁食、肛门排气及服用通便药物后好转；术后切口浅表感染1例，经清创换药及抗感染治疗后痊愈。结论：OLIF手术治疗退行性腰椎疾病存在一定程度的术中/后并发症发生率，积极地对症处理可以获得良好的预后。

英文摘要:

  【Abstract】 Objectives: To summarize the complications and interventions of oblique lateral interbody fusion(OLIF) in the treatment of degenerative lumbar disease. Methods: A total of 78 patients treated with OLIF in our hospital from July 2016 to February 2018 were retrospectively studied, including 37 males and 41 females. The average age was 54.2±7.9 years old(45-78 years old). The average follow-up period was 18.3±4.1months(13-36 months). There were 25 cases of degenerative lumbar spinal stenosis(32.1%), 23 cases of degenerative lumbar scoliosis(29.5%), 18 cases of degenerative lumbar spondylolisthesis(23.1%), and 12 cases of discogenic low back pain(15.4%). Operative segments were as follows: L2/3 in 31 cases, L3/4 in 47 cases, L4/5 in 37 cases. There were 52 cases of single segment fusion, 15 cases of double level fusion and 11 cases of three level fusion. Six patients received posterior pedicle screw fixation in the first or second stage, and 72 patients did not receive posterior pedicle screw fixation. Statistical analysis was used to analyze the operation time, bleeding loss, intraoperative and postoperative complications. Results: All patients completed the operation successfully and the average operation time was 130±55min(45-351min). The average intraoperative blood loss was 118±76ml(50-2500ml). Complications were observed in 18 patients. Of the intraoperative complications, 2 cases with endplate injury received posterior screw fixation in one-stage surgery, and no complications occurred at the last follow-up; 1 case had segmental artery injury and was treated by intraoperative ligation and no further abnormal manifestations occurred after the surgery; 1 case of left common iliac vein injury, which was repaired after using hemostatic materials and blood transfusion after the operation. The lower limb swelling occurred and subsided after affected limb elevation and anticoagulation; 1 case of peritoneal injury received intraoperative repair and intestinal function recovered the next day after operation. Of the postoperative complications, 4 cases of cage subsidence or shifting and all of them were treated with posterior screw fixation in the second stage; 3 cases of pain and numbness in front of the thigh were treated with neurotrophic drugs and the symptoms were significantly improved in 1 week; 2 cases of lower limbs abnormal skin temperature and sensation received neurotrophic therapy and recovered during the 4 months follow-up; 2 cases of asymptomatic pseudarthrosis received no special treatment; 1 case of incomplete intestinal obstruction improved after fasting, exhausting and taking chathartic; 1 case of postoperative superficial incision infection recovered after debridement, dressing change and anti-infection. Conclusions: There were some exactly intraoperative and postoperative complications in OLIF surgury and active symptomatic treatment had a good prognosis.