斜外侧椎间融合术联合侧方椎体螺钉固定治疗腰椎间隙感染的早期临床疗效

Early clinical efficacy of oblique lateral interbody fusion combined with lateral fixation for lumbar intervertebral infection

中文关键词:  腰椎感染  斜外侧腰椎椎间融合术  微创  临床疗效

英文关键词:Lumbar intervertebral infection  Oblique lateral interbody fusion(OLIF)  Minimally invasive  Clinical protocols

中文摘要:

  【摘要】 目的：探讨斜外侧腰椎椎间融合术（oblique lateral interbody fusion，OLIF）联合侧方椎体螺钉固定治疗腰椎间隙感染的早期临床疗效。方法：回顾性分析2014年12月～2017年12月我院收治的12例应用OLIF联合侧方椎体螺钉固定治疗的腰椎间隙感染患者，其中男8例，女4例；年龄35～73岁，平均56.5±13.0岁；病变节段L1/2 1例，L2/3 3例，L3/4 6例，L4/5 2例。术后根据病理及药敏结果给予抗感染治疗，监测红细胞沉降率及C反应蛋白评估疾病控制情况，通过视觉模拟疼痛评分（visual analogue scale，VAS）、腰椎日本骨科协会（Japanese Orthopedic Association，JOA）功能评分和影像学检查（X线片及CT）综合评估临床疗效。结果：手术时间96～164min，平均122±9min，术中出血210～550ml，平均290±22ml。3例术前伴有脊髓神经损伤的患者神经功能Frankel分级均由D级恢复至E级。腰痛VAS评分由术前的8.4±2.7分降至末次随访时的1.5±0.6分，末次随访时JOA评分改善率优8例（66.7％），良4例（33.3％），总体优良率100％。术后所有患者的脊柱前凸及病变节段高度均得到恢复，但在随访过程中脊柱前凸和病变节段高度出现不同程度丢失。术后6个月X线平片及CT扫描示11例患者Ⅰ级融合，1例患者Ⅱ级融合，无假关节形成，无内固定物松动、断裂。1例出现术侧屈髋乏力症状，1例出现手术对侧大腿前方麻木，症状均在2周内完全缓解。结论：OLIF联合侧方椎体螺钉固定治疗腰椎间隙感染，取得了良好的近期临床疗效，尤其适用于感染主要累及脊柱前中柱的患者。

英文摘要:

  【Abstract】 Objectives: To investigate the early clinical outcomes of oblique lateral interbody fusion(OLIF) combined with lateral fixation for the treatment of lumbar intervertebral infection. Methods: Twelve cases(8 males, 4 females) with lumbar intervertebral infection that underwent OLIF combined with lateral fixation from December 2014 to December 2017 were retrospectively reviewed, with a mean age of 56.5±13.0 years(range 35-73 years). The distribution of operative level: L1/2 in 1 case, L2/3 in 3 cases, L3/4 in 6 cases and L4/5 in 2 cases. After operation, anti-infective treatment was given according to pathological results and drug sensitivity test, and the erythrocyte sedimentation rate and C-reactive protein were monitored to evaluate the condition of disease control. Clinical efficacy were comprehensively evaluated by visual analogue scale(VAS), Japanese Orthopedic Association(JOA) scores and radiographic measurements. Results: The operation time was 96-164mins, with a mean time of 122±9mins. The intraoperative blood loss was 210-550ml, with a mean value of 290±22ml. In 3 patients with preoperative neurological defects, Frankel grade was improved from grade D preoperatively to grade E postoperatively indicating their neurological functions were restored. The VAS score decreased from 8.4±2.7 preoperatively to 1.5±0.6 at final follow-up. The JOA score showed that the treatment was effective in all patients, including excellent in 8 cases and good in 4 cases, with an overall excellent and good rate of 100%. The segmental height and lordosis were all well restored after operation, but different degrees of loss were founded during the follow-up. X-ray and CT scan performed at 6 months after operation showed 11 cases of grade I fusion, and 1 case of grade II fusion, with no pseudoarthrosis formation nor internal fixation loosening or fracture. There was 1 case of ipsilateral hip flexor weakness, and 1 case of contralateral thigh numbness, the symptoms were relieved within 2 weeks. Conclusions: Oblique lateral interbody fusion(OLIF) combined with lateral fixation was clinically effective for lumbar intervertebral infection, especially for infection mainly involved in anterior and middle spinal columns.