单纯斜外侧腰椎椎间融合术后融合器沉降与腰椎矢状面参数的关系

The relationship between cage subsidence and lumbar sagittal alignment after oblique lumbar interbody fusion stand-alone

中文关键词:  斜外侧腰椎椎间融合术  融合器沉降  腰椎前凸  矢状面参数

英文关键词:Oblique lumbar interbody fusion  Cage subsidence  Lumbar lordosis  Lumbar sagittal alignment

中文摘要:

  【摘要】 目的：探讨单纯斜外侧腰椎椎间融合术（oblique lumbar interbody fusion，OLIF）术后融合器沉降与腰椎矢状面参数之间的关系。方法：回顾性分析117例接受单节段OLIF手术（无内固定）患者的临床资料，根据椎间隙高度（disc height，DH）下降程度分为融合器0级沉降组（0～24%）、Ⅰ级沉降组（25%～49%）、Ⅱ级沉降组（50%～74%）、Ⅲ级沉降组（75%～100%）。术后随访2年以上，比较各组间手术前后DH改善值（术后即刻DH-术前DH）、节段前凸角（segmental lordosis，SL）改善值（术后即刻SL-术前SL）、腰椎前凸角（lumbar lordosis，LL）改善值（术后即刻LL-术前LL）及末次随访时SL丢失值（末次随访SL-术后即刻SL）、LL丢失值（末次随访LL-术后即刻LL）。比较各组间术后1周及末次随访时的疼痛视觉模拟评分（visual analog scale，VAS）、Oswestry功能障碍指数（Oswestry disability index，ODI）。回归分析融合器沉降的危险因素。结果：本组中0级沉降106例，Ⅰ级沉降11例，未见Ⅱ级、Ⅲ级沉降，其中5例Ⅰ级沉降病例行再次手术。Ⅰ级沉降组手术前后DH改善值、SL改善值明显大于0级沉降组（P<0.05），LL改善值与0级沉降组比较差异无统计学意义（P＞0.05），手术前后DH改善值、SL改善值是融合器沉降的独立危险因素。Ⅰ级沉降组末次随访时SL丢失值、LL丢失值均明显大于0级沉降组（P<0.05）。两组患者术后VAS评分、ODI均较术前明显改善（P＜0.05）。Ⅰ级沉降组术后1个月VAS评分、ODI均高于0级沉降组，差异无统计学意义（P＞0.05）；Ⅰ级沉降组末次随访VAS评分、ODI均显著高于0级沉降组（P＜0.05）。结论：OLIF术中过多撑开椎间隙及增加节段前凸角可能导致融合器沉降，融合器沉降会引起手术节段前凸角及腰椎前凸角丢失，并且影响临床疗效。

英文摘要:

  【Abstract】 Objectives: The purpose of this study was to assess the relationship between cage subsidence and lumbar sagittal alignment after oblique lumbar interbody fusion(OLIF) stand-alone. methods: In this study，the clinical data of 117 consecutive patients who underwent OLIF stand-alone were reviewed. Subsidence was classified using the following scale: grade 0, 0%-24% loss of postoperative disc height(DH); grade Ⅰ, 25%-49%; grade Ⅱ, 50%-74%; and grade Ⅲ, 75%-100%. All the patients were followed up for more than 2 years. DH improvement(postoperative DH-preoperative DH), segmental lordosis(SL) improvement(postoperative SL-preoperative SL), lumbar lordosis(LL) improvement(postoperative LL-preoperative LL) were evaluated, decrease of postoperative SL and LL were also recorded. Visual analogue scale(VAS) and Oswestry disability index(ODI) were compared. Logistic regression for cage subsidence after OLIF stand-alone was done. Results: All the operations were successfully done. 106 patients had grade 0 subsidence, 11 patients had grade Ⅰ subsidence, there was no grade Ⅱ, grade Ⅲ subsidence. 5 patients with grade Ⅰ subsidence underwent reoperation. The DH improvement and SL improvement in grade Ⅰ subsidence group was significantly larger than that in grade 0 subsidence group(P＜0.05). There was no significant difference in LL improvement in the two groups(P>0.05), DH improvement and SL improvement are independent risk factors for cage subsidence. The SL decrease and LL decrease in grade Ⅰ subsidence group was significantly larger than that in grade 0 subsidence group(P＜0.05). There was a significant decrease in VAS and ODI at all examinations postoperation(P＜0.05)， When comparing the two groups, The VAS scores and ODI scores in grade Ⅰ subsidence group was larger than that in grade 0 subsidence group at 1 month follow-up, but without statistical significance. The VAS scores and ODI scores in grade Ⅰ subsidence group was significantly larger than that in grade 0 subsidence group at the final follow-up(P＜0.05). Conclusions: In OLIF stand-alone, excessive reconstruction of DH and SL may lead to cage subsidence. Cage subsidence could result in SL and LL decrease, and affect clinical outcome.