斜外侧腰椎间融合术治疗腰椎融合术后症状性邻近节段退变的临床疗效分析

Clinical outcome of OLIF in the treatment of symptomatic ASD after lumbar fusion

中文关键词:  斜外侧腰椎间融合术  邻近节段退变  腰椎融合术后  腰椎退变性疾病  临床疗效

英文关键词:Oblique lumbar interbody fusion  Adjacent segment degeneration  Posterior lumbar interbody fusion  Lumbar degenerative disease  Clinical outcomes

中文摘要:

  【摘要】 目的：探讨斜外侧腰椎间融合术（OLIF）治疗腰椎融合术后症状性邻近节段退变的近期疗效。方法：回顾性分析我院2015年1月~2018年7月采用手术治疗腰椎融合术后症状性邻近节段退变患者62例。采用OLIF治疗38例，男16例，女22例，年龄39～74岁，平均58.2±14.5岁；采用后路腰椎椎体间融合术（PLIF）治疗24 例，男13例，女11例，年龄41～70岁，平均56.6±11.7岁。记录手术时间、术中出血量、并发症情况评估患者的围手术期情况。记录并比较术前、术后3个月、末次随访时腰痛和患肢痛视觉模拟评分（VAS）、Oswestry功能障碍指数（ODI）评定临床疗效。通过测量腰椎正侧位X线片比较术前、末次随访时椎间隙高度（IDH）、椎间孔高度（IFH）、椎间孔面积（IFA）改变情况比较影像学改善情况。结果：两组患者随访时间18.4±8.2个月（8~36个月）。OLIF 组术中出血量129.2±15.2ml，手术时间81.2±17.4min；PLIF 组术中出血量205.6±23.8ml，手术时间127.8±26.2min，OLIF 组均较PLIF 组显著降低（P<0.05）。OLIF组未发生血管、神经、腹膜、脏器损伤等术中并发症，PLIF组出现3例术中硬膜囊破裂，行术中硬膜囊修补术，其中2例出现术后脑脊液漏。OLIF组术后3个月时腰痛、患肢痛VAS评分、ODI为2.39±0.82分、1.43±0.58分、（20.61±4.24）%；末次随访时腰痛、患肢痛VAS评分、ODI为1.97±0.66分、1.22±0.75分、（13.47±4.56）%。PLIF组术后3个月时腰痛、患肢痛VAS评分、ODI为2.75±1.28分、1.54±0.79分、（21.88±5.94）%；末次随访时腰痛、患肢痛VAS评分、ODI为1.60±1.14分、1.61±1.15分、（15.12±4.71）%。两组术后VAS评分与ODI均较术前显著改善（P<0.05）,但两组间同时间点比较无显著性差异（P>0.05）。OLIF组末次随访时IDH、IFH、IFA分别为10.54±0.88mm、20.86±2.67mm、206.24±11.45mm2；PLIF组末次随访时IDH、IFH、IFA分别为8.52±1.27mm、23.18±2.26mm、227.74±12.89mm2。两组末次随访时IDH、IFH、IFA均较术前显著改善（P<0.05），两组间比较无统计学差异（P>0.05）。结论：OLIF和PLIF治疗腰椎融合术后症状性邻近节段退变临床疗效一致，但OLIF在缩短手术时间、减少手术相关并发症方面具有优势。

英文摘要:

  【Abstract】 Objectives: To explore the short-term clinical outcome of oblique lumbar interbody fusion (OLIF) in symptomatic adjacent segment degeneration (ASD) after lumbar fusion. Methods: Retrospective studied 62 patients with symptomatic ASD after lumbar fusion treated in our hospital from January 2015 to July 2018 . 38 patients were treated with OLIF (16 males and 22 females, aged 39-74 years, mean age 58.2±14.5 years), and 24 patients with PLIF (13 males and 11 females, aged 41-70 years, mean age 56.6±11.7 years). The perioperative condition of the patients was evaluated by recording the operation time, intraoperative blood loss, and complications. The clinical efficacy of both groups were assessed by comparing the scores of low back pain and visual analogue scale (VAS) and Oswestry disability index ODI recorded before surgery, 3 months after, and the final follow-up. The radiological improvements were compared by measuring intervertebral disc height (IDH), intervertebral foramen height (IFH) and intervertebral foramen area (IFA) on X-ray before and at the final follow-up. Results: The follow up periods for the 62 patients were from 8 to 36 months (average, 18.4±8.2 months). The mean operation time and blood loss in group OLIF were significantly less than those in group PLIF (81.2±17.4min vs 127.8±26.2min, 129.2±15.2ml vs 205.6±23.8ml, P<0.05). No intraoperative complications such as injuries on blood vessels, nerves, peritoneum and organs were observed in OLIF group. There were 2 cases of cerebrospinal fluid leakage in the PLIF group. The clinical outcome of all the patients improved during the follow-up. In the OLIF group, the mean VAS scores of back pain, lower limb pain and ODI were 2.39±0.82, 1.43±0.58 and (20.61±4.24)% at 3 months after the operation; and 1.97±0.66, 1.22±0.75 and (13.47±4.56)% at the final follow-up. In the PLIF group, the mean VAS scores of back pain, lower limb pain and ODI were 2.75±1.28, 1.54±0.79 and (21.88±5.94)% at 3 months after; and 1.60±1.14, 1.61±1.15 and (15.12±4.71)% at the last follow-up. The mean VAS scores and ODI at 3 months after operation and final follow-up were improved significantly (P<0.05) in both groups comparing to the preoperative datas, yet there was no statistical difference (P>0.05) between the two groups. At final follow-up, IDH, IFH and IFA were 10.54±0.88mm, 20.86±2.67mm and 206.24±11.45mm2 in OLIF group and were 8.52±1.27mm, 23.18±2.26mm and 227.74±12.89mm2 in PLIF group. Both groups saw significantly increase in IDH, IFH and IFA compared with those before operation(P<0.05), but there was no statistically significant difference between the two groups(P>0.05). Conclusions: OLIF and PLIF have the same clinical outcomes in the treatment of symptomatic adjacent segment degeneration after lumbar fusion, but OLIF has advantages of shorter operation time and less complications.