极外侧入路椎体间融合术治疗腰椎管狭窄症的初期疗效

Early curative effect of extreme lateral interbody fusion for the treatment of lumbar spinal stenosis

中文关键词:  腰椎管狭窄症  侧路椎间融合术  微创

英文关键词:Lumbar spinal stenosis  Lateral interbody fusion  Minimally invasive

中文摘要:

  【摘要】 目的：观察极外侧入路椎体间融合术（extreme lateral interbody fusion，XLIF）治疗退行性腰椎管狭窄症的初期疗效。方法：2012年7月~2017年3月在广州军区广州总医院采用XLIF治疗41例退行性腰椎管狭窄症患者，男15例，女26例，年龄64.4±9.8（39～83）岁，手术节段共51节。临床疗效评价包括术前及末次随访时的腰腿痛VAS评分、Oswestry功能障碍指数（ODI）及腰椎JOA评分。影像学评价包括在腰椎侧位X线片上测量手术节段的术前、术后1周及末次随访时的椎间孔高度、椎间隙高度（椎体后缘测量）和椎间孔面积，在术前和术后1周的MRI（T2加权）图像上测量手术节段的轴位椎管矢状径和椎管最狭窄处面积。根据内固定方式分为两组：侧方钢板组，21例，26个节段；后路螺钉组，20例，25个节段。比较总体的术前、术后1周、末次随访的差异以及两组的手术前后变化的差异。结果：每节段手术时间为92.12±45.95min（50～260min），每节段术中出血量56.34±58.81ml（10～225ml）。11例患者术后出现短暂性大腿前外侧麻木，均于术后1~6周症状减轻或消失；均无脑脊液漏，无大血管、腹腔脏器、生殖股神经等损伤。随访22.39±13.18个月（6～63个月），13例（31.7%）患者出现融合器下沉，其中11例为Ⅰ级，2例为Ⅱ级，均无临床症状。末次随访时41例患者的腰腿痛VAS评分、ODI及腰椎JOA评分均较术前显著改善（P<0.05）。术后1周手术节段的椎间隙高度、椎间孔高度、椎间孔面积、轴位椎管矢状径、椎管最狭窄处面积及末次随访时手术节段的椎间隙高度、椎间孔高度和椎间孔面积均较术前明显改善，有统计学差异（P<0.05）。对比两种内固定方式，术后1周手术节段的椎间孔高度、椎间隙高度、椎间孔面积、轴位椎管矢状径和椎管最狭窄处面积的变化值均无统计学差异（P>0.05）；末次随访时侧方钢板组手术节段的椎间隙高度与椎间孔面积丢失比后路螺钉组多，两组之间有统计学差异（P<0.05）。结论：XLIF治疗退行性腰椎管狭窄症具有良好的初期临床疗效。

英文摘要:

  【Abstract】 Objectives: To investigate the early curative effect of extreme lateral interbody fusion(XLIF) in the treatment of degenerative lumbar spinal stenosis. Methods: Total 41 patients who underwent XLIF surgery for degenerative lumbar spinal stenosis in General Hospital of Guangzhou Military Command from July 2012 to March 2017 were retrospectively reviewed. There were 15 males and 26 females, the mean age was 64.4±9.8(range, 39-83) years old, with a total of 51 operative segments. Clinical efficacy evaluation included VAS score, Oswestry disability index(ODI) score and JOA score of lumbar spine before surgery and at the last follow-up. Imaging evaluation included measuring the foraminal height, dics height and foraminal area on the lateral X-ray before surgery, one week after surgery, and at the last follow-up. The anterior-posterior diameter of the canal and the cross-sectional area of the canal on MRI(T2-weighted) images was measured before surgery, one week after surgery, and at the last follow-up. Patients were divided into two groups according to the internal fixation: side screw group(21 cases, 26 segments) and posterior screw group(20 cases, 25 segments). Overall data of preoperation, postoperative 1 week, and final follow-up, as well as the changes in different groups before and after surgery were compared. Results: The average operation time per segment was 92.12±45.95min(50-260min), and the average bleeding was 56.34±58.81ml(10-225ml) for each segment. 11 patients had occured transient anterolateral thigh numbness after operation, and the symptoms were relieved or disappeared gradually within 1 to 6 weeks after operation. However, there was no cerebrospinal fluid leakage, major blood vessels, abdominal organs, reproductive femoral nerves or other injuries. During follow-up, cage subsidence was found in 13 patients(31.7%), among whorm 11 were GradeⅠand 2 were Grade Ⅱ. The average follow-up time was 22.39±13.18(6-63) months. Overall, VAS score, ODI score and JOA score of lumbar spine at the last follow-up were significantly improved(P<0.05). Disc height, foraminal height, foraminal area, anterior-posterior diameter of the canal, cross-sectional area of the canal within 1 week after operation, and disc height, foraminal height, foraminal area at the last follow-up were significantly improved compared to the preoperative ones, with statistical differences(P<0.05). There were no significant differences in the values of foraminal height, disc height, foraminal area, anterior-posterior diameter of the canal and cross-sectional area of the canal between the two groups(P>0.05). At the last follow-up, the disc height and foraminal area loss in the side screw group were more than those in the posterior screw group, with statistical significance(P<0.05). Conclusions: XLIF for the treatment of degenerative lumbar spinal stenosis has a good early curative effect.