斜向腰椎椎间融合术治疗腰椎退行性疾病的临床疗效

Clinical outcomes of oblique lumber interbody fusion in lumbar degenerative disease

中文关键词:  斜向腰椎椎间融合术  腰椎退行性疾病  临床疗效

英文关键词:Oblique lumber interbody fusion  Lumbar degenerative disease  Clinical outcome

中文摘要:

  【摘要】 目的：探讨应用斜向腰椎椎间融合术治疗腰椎退行性疾病的临床疗效。方法：对2015年10月～2016年5月应用斜向腰椎椎间融合术治疗的24例腰椎退行性疾病患者进行回顾性分析，男8例，女16例，年龄44～88岁，平均62.3±12.0岁，手术节段36节。观察手术时间、出血量、术后并发症，比较术前、术后1周、末次随访时腰痛JOA评分、Oswestry功能障碍指数（ODI）情况及X线片上手术节段椎间隙高度（intervertebral disc height，IDH）和椎间孔高度（intervertebral foramen height，IFH）变化。结果：平均手术时间135±21.0min（100~170min），平均术中出血量163.3±54.9ml（100～300ml）。平均随访时间15.8±2.2个月（13～20个月）。末次随访时7例患者发生融合器下沉，下沉节段10节，其中2例患者未行后路椎弓根螺钉固定，2例患者术中有明确终板损伤；3例出现一过性大腿前方疼痛，1例出现下肢乏力，1周后恢复正常。所有患者症状在随访过程中均逐渐改善，术前、术后1 周及末次随访时平均腰痛JOA评分分别为11.2±1.9、19.4±1.3、25.0±0.72，术后1周与末次随访与术前比较均有统计学差异（P<0.01）；平均ODI分别为（68.5±5.9）%、（45.6±5.65）%、（12.2±5.1）%，术后1周与末次随访与术前比较均有统计学差异（P<0.01）；平均椎间隙高度分别为9.16±2.7mm、12.7±2.6mm、10.8±3.0mm，术后1周与术前比较有统计学差异（P<0.01），末次随访与术前比较无统计学差异（P>0.05）；平均椎间孔高度16.9±3.7mm、20.7±3.7mm、18.1±4.2mm，术后1周与术前比较有统计学差异（P<0.01），末次随访与术前比较无统计学差异（P>0.05）。结论：斜向腰椎椎间融合术近期疗效好、安全性高，能有效治疗腰椎退行性疾病，远期疗效还需经过大样本长期的随访和研究。

英文摘要:

  【Abstract】 Objectives: To analyze the clinical outcomes of oblique lumber interbody fusion(OLIF) in treating lumbar degenerative disease. Methods: 24 cases were selected who had lumbar degenerative disease and treated with oblique lumber interbody fusion between October 2015 and May 2016. The operations were performed in 36 segments of 8 males and 16 females, with an average age of 62.3±12.0(range, 44-88) years old. Lumbar function was evaluated according to Japanese Orthopaedic Association(JOA) score and Oswestry disability index(ODI). The intervertebral disc height(IDH) and intervertebral foramen height(IFH) were measured on lumbar plane X-ray before surgery, 1 week after surgery and at final follow-up after operation. The operation time, blood loss and postoperative complication were observed, and then the causes were analyzed. Results: The mean operation time was 135±21.0 minutes(100-170 minutes); and the mean blood loss was 163.3±54.9ml(100-300ml). The average follow-up time was 15.8±2.2 months(13-20 months). 7 cases(10 segments) occurred cage subsidence, 2 of them were not placed posterior pedicle screw fixation, and 2 of them had intra-operative end plate damage. 3 cases experienced transient pain in the front of legs and 1 case lower limbs weakness, but recovered 1 week later. The clinical outcomes of all the patients improved during the follow-up. Before surgery, 1 week after surgery and at final follow-up, the mean JOA scores were 11.2±1.9, 19.4±1.3, 25.0±0.72, the mean ODI scores were (68.5±5.9)%, (45.6±5.65)%, (12.2±5.1)%, respectively. All the clinical outcomes after surgery improved significantly comparing with those before surgery(P<0.01). At the three time points, the mean IDH was 9.16±2.7mm, 12.7±2.6mm, 10.8±3.0mm, the mean IFH was 16.9±3.7mm, 20.7±3.7mm, 18.1±4.2mm. The radiographic outcomes at 1 week after surgery improved significantly comparing with those before surgery(P<0.01), and the outcomes of final follow-up did not improved significantly comparing with those before surgery(P>0.05). Conclusions: Oblique lumber interbody fusion has satisfying and safe short-term outcomes in lumbar degenerative disease. Further follow-up and research is needed to access the long-term outcomes.