自锚式腰椎侧方融合器在斜外侧椎间融合术治疗腰椎融合术后邻近节段病中的应用

Application of self-anchored lateral lumbar fusion cages in oblique lateral interbody fusion for symptomatic adjacent segment degeneration after lumbar fusion

中文关键词:  自锚式腰椎侧方融合器  斜外侧椎间融合术  腰椎融合术后  邻近节段病变

英文关键词:Self-anchored lateral lumbar fusion cage  Oblique lateral interbody fusion  Posterior lumbar interbody fusion  Adjacent segment disease

中文摘要:

  【摘要】 目的：评价自锚式腰椎侧方融合器在斜外侧椎间融合（oblique lateral interbody fusion，OLIF）术治疗腰椎融合术后邻近节段病中的应用效果。方法：2014年3月～2020年3月在我院治疗的腰椎融合术后症状性邻近节段退变患者35例，其中采用自锚式腰椎侧方融合器行斜外侧椎间融合术13例（OLIF组），男7例，女6例；年龄48～75岁（56.2±15.4岁）。采用后方经椎间孔腰椎椎间融合（transforaminal lumbar interbody fusion，TLIF）术22例（TLIF组），男12例，女10例；年龄38～76岁（48.2±24.5岁）。比较两组患者的手术时间、术中出血量、术后引流量、住院时间和并发症发生率，在术前、术后3个月和末次随访时采用视觉模拟评分（visual analogue scale，VAS）评定腰痛和腿痛情况、Oswestry功能障碍指数（Oswestry disability index，ODI）评定临床疗效。结果：OLIF组的手术时间、术中出血量、术后引流量、住院时间均小于TLIF组，差异均有统计学意义（P<0.05）。OLIF组术后出现并发症3例（23.1%），TLIF组术后出现并发症5例（22.7%），两组并发症发生率无统计学差异（P>0.05）。术后随访12~72个月（35.4±21.9个月），OLIF组术前、术后3个月和末次随访时的腰痛、腿痛VAS评分和ODI分别为7.6±1.1分、7.8±1.1分、（58.9±10.8）％，1.7±0.3分、1.8±0.2分、（19.6±1.5）％和0.7±0.3分、0.7±0.3分、（18.3±0.7）％；TLIF组分别为8.0±1.0分、8.0±1.0分、（57.4±11.5）％，1.8±0.3分、1.9±0.3分、（20.9±1.2）％和0.5±0.1分、0.5±0.2分、（19.2±0.8）％；两组术后3个月及末次随访时的腰、腿痛VAS评分及ODI均较术前显著性改善（P<0.05），两组同时间点比较差异均无统计学意义（P>0.05）。结论：应用自锚式腰椎侧方融合器行OLIF治疗腰椎融合术后邻近节段病安全、有效，并能够缩短手术时间和住院时间，有利于早期康复。

英文摘要:

  【Abstract】 Objectives: To evaluate the application effect of self-anchored lateral lumbar fusion cage in the treatment of symptomatic adjacent segment degeneration after lumbar fusion by oblique lateral interbody fusion(OLIF). Methods: Retrospective analysis was performed on 35 patients with symptomatic adjacent segment degeneration after lumbar fusion treated in our hospital from March 2014 to March 2020. 13 patients were treated with OLIF(7 males and 6 females, aged 48－75 years, with a mean age of 56.2±15.4 years)， and 22 patients were treated with transforaminal lumbar interbody fusion(TLIF)(12 males and 10 females, aged 38-76 years, averaged 48.2±24.5 years)． Perioperative conditions, such as operative time, intraoperative blood loss, postoperative drainage volume, length of hospital stay and complications, were recorded for both groups. The clinical efficacy of both groups were assessed by comparing the visual analogue scale(VAS) scores of back pain and lower limb pain and Oswestry disability index(ODI) recorded before surgery, 3 months after operation, and the final follow-up. Results: There were statistically significant differences in operative time, intraoperative blood loss, postoperative drainage volume and length of hospital stay between the two groups(P<0.05). Postoperative complications occurred in 3 cases(23.1%) in the OLIF group, and in 5 cases(22.7%) in the TLIF group. Follow-up period was 35.4±21.9 months(ranged 12-72 months). In the OLIF group, the mean VAS scores of back pain, lower limb pain and ODl were 7.6±1.1, 7.8±1.1, (58.9±10.8)％ before surgery; 1.7±0.3, 1.8±0.2, (19.6±1.5)% at 3 months after the operation; and 0.7±0.3, 0.7±0.3, (18.3±0.7)% at the final follow-up． In the TLIF group, the mean VAS scores of back pain, lower limb pain and ODl were 8.0±1.0, 8.0±1.0, (57.4±11.5)％ before surgery; 1.8±0.3, 1.9±0.3, (20.9±1.2)% at 3 months after the operation; and 0.5±0.1, 0.5±0.2, (19.2±0.8)% at the final follow-up． The VAS scores of back pain, lower limb pain and ODI scores of the two groups of patients at 3 months postoperatively and at the last follow-up were improved compared with those preoperatively(P<0.05). There was no statistically significant difference between the two groups at different points(P>0.05). Conclusions: OLIF with self-anchored lumbar lateral fusion cage is safe and effective in the treatment of adjacent segmental disease after lumbar fusion, and can shorten the operation time and hospital stay, and facilitate early recovery.