“O”型臂导航下后路截骨与斜外侧腰椎间融合术治疗退行性脊柱侧凸的疗效分析

Analysis of efficacies of posterior osteotomy and oblique lumbar interbody fusion under O-arm navigation in the treatment of degenerative scoliosis

中文关键词:  退变性疾病  脊柱侧凸  外科手术，计算机辅助  脊柱融合术

英文关键词:Degenerative diseases  Scoliosis  Surgery  Computer-aided  Spinal fusion

中文摘要:

  【摘要】 目的：探讨后路“O”型臂导航内固定+截骨矫形术和前路斜外侧腰椎间融合术（oblique lumbar interbody fusion，OLIF）+后路“O”型臂导航内固定术治疗退行性脊柱侧凸患者的临床疗效及安全性。方法：回顾性分析2016年5月～2023年6月期间，本院手术治疗的退行性脊柱侧凸患者55例，根据手术方式分为后路“O”型臂导航内固定+截骨矫形组（A组，20例）和前路OLIF+后路“O”型臂导航内固定组（B组，25例）。A组男8例，女12例；年龄47～81岁（66.4±7.4岁）；B组男8例，女17例；年龄52～81岁（67.4±8.2岁）。记录患者围术期数据，于术前、术后1周及末次随访时填写疼痛视觉模拟评分（visual analogue scale，VAS）和Oswestry功能障碍指数（Oswestry disability index，ODI）以评估临床疗效；同时拍摄脊柱全长站立位X线片，测量冠状位侧凸Cobb角、矢状面平衡（sagittal vertical axis，SVA）、腰椎前凸角（lumbar lordosis，LL）、椎间隙高度、椎体融合率等数据，记录并发症情况。结果：所有患者均获随访，随访时间A组18～38个月（26.5±5.3个月）；B组20～36个月（24.3±4.2个月），差异比较无统计学意义（P＞0.05）。A组手术时间、术中出血量、术后引流量及术后起床时间、输血人次分别为219.0±25.7min、1087.5±353.1mL、364.7±22.9mL、11.0±3.4d、18次；B组为169.4±25.6min、672.5±308.6mL、109.3±25.3mL、6.3±1.8d、8次，两组比较差异均有统计学意义（P＜0.05）。术后、末次随访腰痛VAS评分A组为6.2±0.9分、1.8±0.8分；B组为4.4±0.9分、1.3±0.5分，B组均低于A组（P＜0.05）。术后A组ODI为（22.8±4.8）％，B组为（19.9±2.9）％，B组低于A组（P＜0.05）；末次随访时两组ODI比较差异无统计学意义（P＞0.05）。A组术后、末次随访时矢状面SVA为47.0±11.5mm、43.9±19.7mm；B组为35.2±19.9mm、30.9±19.9mm，A组矢状面矫正均优于B组（P＜0.05）。术后、末次随访两组冠状面Cobb角、LL比较差异无统计学意义（P＞0.05）。A组术后、末次随访时椎间隙高度为48.1±8.2mm、46.1±8.5mm；B组为57.4±5.4mm、56.3±5.6mm，B组优于A组（P＜0.05）。A组患者术后脑脊液漏2例，切口愈合延迟2例，钉棒断裂1例，螺钉松动1例，并发症发生率为30%（6/20）；B组患者2例术后出现左大腿前内侧疼痛，2例患者出现短暂的左侧屈髋无力，均在随访时恢复，并发症发生率为16%（4/25），并发症发生率比较A组高于B组（P＜0.05），所有患者无切口感染、脊髓损伤并发症，末次随访时植骨及融合器均骨性融合。结论：后路“O”型臂导航内固定+截骨矫形术和前路OLIF+后路“O”型臂导航内固定术治疗退行性脊柱侧凸均可取得满意临床疗效，前者矢状面矫形效果更好，但存在手术时间长、出血量多、术后卧床时间久、并发症多等问题，后者冠状面侧弯矫形效果不亚于前者，同时具有微创、创伤小、恢复快及并发症少等优点，可为退行性脊柱侧凸的微创治疗提供新的选择。

英文摘要:

  【Abstract】 Objectives: To investigate the clinical efficacy and safety of posterior O-arm navigated internal fixation+osteotomy orthopedic surgery and anterior oblique lumbar interbody fusion(OLIF)+posterior O-arm navigated internal fixation in the treatment of patients with degenerative scoliosis. Methods: A retrospective analysis was performed on the 55 patients with degenerative scoliosis who were treated in our hospital between May 2016 and June 2023. According to surgical method, the patients were divided into posterior O-arm navigated internal fixation+osteotomy orthopedic group(group A, 20 cases) and anterior OLIF+posterior O-arm navigated internal fixation group(group B, 25 cases). Group A consisted of 8 males and 12 females, aged 47-81(66.4±7.4) years old; Group B consisted of 8 males and 17 females, aged 52-81(67.4±8.2) years old. The perioperative data of the patients were collected, and the visual analogue scale(VAS) score and Oswestry disability index(ODI) were recorded before operation, at postoperative 1 week and final follow-up to evaluate the clinical efficacy, and full-length spinal X-ray were taken in the standing position at the same time point to measure the coronal Cobb angle, sagittal vertical axis(SVA), lumbar lordosis(LL), intervertebral space height, vertebral fusion rate. The complications were recorded and compared between groups. Results: The patients were followed up for 18-38(26.5±5.3) months in group A and 20-36(24.3±4.2) months in group B, with no statistical difference(P>0.05). Statistical differences(P<0.05) were observed between group A and group B in operative time(219.0±25.7min vs 169.4±25.6min), intraoperative blood loss(1087.5±353.1mL vs 672.5±308.6mL), postoperative drainage volume(364.7±22.9mL vs 109.3±25.3mL), postoperative ambulation time(11.0±3.4d vs 6.3±1.8d), and number of blood transfusions(18 vs 8). The VAS scores were 6.2±0.9 points and 1.8±0.8 points in group A at postoperative 1 week and final follow-up respectively, which were 4.4±0.9 and 1.3±0.5 in group B, and group B was lower than group A at the same postoperative time point(P<0.05). The ODI of group A and group B at postoperative 1 week were (22.8±4.8)% and (19.9±2.9)%, and group B was lower than group A(P<0.05), while there was no significant difference between the two groups at final follow-up(P>0.05). At postoperative 1 week and final follow-up, the sagittal SVA of group A was 47.0±11.5mm and 43.9±19.7mm, which was 35.2±19.9mm and 30.9±19.9mm in group B, and the sagittal correction in group A was better than that in group B(P<0.05). There was no statistical difference between the two groups in coronal Cobb angle and LL at postoperative 1 week and final follow-up(P>0.05). The intervertebral space height of group A was 48.1±8.2mm and 46.1±8.5mm at postoperative 1 week and final follow-up, which was 57.4±5.4mm and 56.3±5.6mm in group B, and group B was better than group A(P<0.05). There were 2 cases of postoperative cerebrospinal fluid leakage, 2 cases of delayed incision healing, 1 case of nail and rod fracture, 1 case of screw loosening in group A, and the complication rate was 30%(6/20); 2 cases in group B had postoperative pain on the anteromedial side of the left thigh, and 2 cases had transient left hip flexion weakness, all of which recovered at follow-up, and the complication rate was 16%(4/25). The complication rate was higher in group A than group B(P<0.05). Both groups had no incision infection or spinal cord injury complications. At final follow-up, the bone graft and fusion device were osseous fusion in both groups. Conclusions: Both posterior O-arm navigated internal fixation+osteotomy orthopedic surgery and anterior OLIF+posterior O-arm navigated internal fixation can achieve satisfactory clinical efficacy in the treatment of degenerative scoliosis, the former has better sagittal orthopedic effect, but has the problems of long operative time, large amount of bleeding, long postoperative bed rest, and many complications, while the latter has a similar scoliosis correction, as well as the advantages of minimally invasive, less traumatic, fast recovery and fewer complications, which can provide a new option for the minimally invasive treatment of degenerative scoliosis.