斜外侧椎间融合术联合侧方一体化钢板固定治疗单节段腰椎退行性疾病的安全性与早期临床疗效

Safety and early clinical efficacy of oblique lateral interbody fusion combined with lateral integrated plate fixation in the treatment of lumbar degenerative diseases

中文关键词:  腰椎退行性疾病  侧方固定  椎弓根螺钉  椎间融合  并发症

英文关键词:Lumbar degenerative diseases  Lateral fixation  Pedicle screw  Interbody fusion  Complication

中文摘要:

  【摘要】 目的：通过与斜外侧椎间融合术（oblique lateral interbody fusion，OLIF）联合后方椎弓根螺钉固定方式的对比，评价OLIF联合侧方一体化钢板固定治疗单节段腰椎退行性疾病的早期结果、临床优势和安全性。方法：回顾性分析我院自2019年6月收治的46例病例，男14例，女32例；年龄30～69岁，平均59.98±6.86岁；疾病类型：腰椎间盘退行性病变18例，腰椎管狭窄症10例，腰椎退行性滑脱Ⅰ度18例；病变部位：L3/4 13例，L4/5 33例；骨密度：T值＞-1.0SD 34例，-2.5SD＜T≤-1.0SD 12例；身体质量指数（body mass index，BMI）16～24kg/m2，平均22.40±1.95（kg/m2）。采用OLIF联合侧方一体化钢板固定治疗21例（简称一体化固定组），OLIF联合后方椎弓根螺钉固定25例（简称联合固定组）。观察并对比两种手术方式的影像、临床结果和并发症。结果：一体化固定组手术时间（49.33±3.94min）和术中出血量（38.70±12.76mL）均明显短于或少于联合固定组（97.40±8.25min和84.60±20.13mL），对比有统计学差异（P＜0.001）。两组病例均获得24～36个月，平均28.29±4.70个月的随访。随访过程中两组病例均出现融合器不同程度的沉降，一体化固定组0级18例，Ⅰ级3例；联合固定组0级25例，Ⅰ级0例，两组间比较差异有统计学意义（P＝0.036）。两组椎间隙高度术后均获得明显的恢复，随访中出现程度不等的丢失，末次随访时，一体化固定组丢失甚于联合固定组，两组间比较有统计学差异（P＝0.046）。两组末次随访时腰椎冠状面和矢状面平衡均获得较好的恢复，两组间比较无统计学差异（P＝0.139，P＝0.149）。两组均获得良好的椎间融合，融合率为100%。虽然末次随访时两组腰痛和腰椎功能均获得明显恢复，但在术后3个月时，一体化固定组好于联合固定组。随访中未出现内固定松动、断裂和融合器移位现象。一体化固定组并发症发生率为4.76%，联合固定组为8.0%，两组间比较无统计学差异（P＝0.082）。结论：在严格病例选择的前提下，OLIF联合一体化钢板固定治疗单节段腰椎退行性疾病具有较好的临床效果和安全性。而且与OLIF联合后方椎弓根螺钉固定方式相比，在手术时间、术中出血量、早期恢复方面优势明显。但一体化固定在提高OLIF融合节段的稳定性方面强度有限，融合器沉降率较高，椎间隙高度维持能力较差。

英文摘要:

  【Abstract】 Objectives: To summarize the early results, clinical advantages and safety of oblique lateral interbody fusion(OLIF) combined with lateral integrated plate fixation in the treatment of single-segment lumbar degenerative diseases by comparing with OLIF combined with posterior pedicle screw fixation. Methods: A retrospective analysis was made on 46 cases(14 males and 32 females) admitted to our hospital since June 2019. The age ranged from 30 to 69 years, with an average of 59.98±6.86 years; Disease types: 18 cases of lumbar disc degeneration, 10 cases of lumbar spinal stenosis, and 18 cases of lumbar degenerative spondylolisthesis; The lesions were located in L3/4 of 13 cases, and L4/5 of 33 cases; Bone mineral density(BMD): T>-1.0SD in 34 cases, -2.5SD＜T≤-1.0SD in 12 cases; BMI: 16-24kg/m2, averaged 22.40±1.95(kg/m)2. 21 cases were treated with OLIF combined with lateral integrated plate fixation(as the integrated fixation group), and the other 25 cases were treated with OLIF combined with posterior pedicle screw fixation(as the combined fixation group). The imaging data, clinical results, and complications of the two surgical methods were observed and compared. Results: The operative time and intraoperative bleeding in the integrated fixation group(49.33±3.94min, 38.70±12.76mL) were significantly shorter than or less than that in the combined fixation group(97.40±8.25min, 84.60±20.13mL), with a statistical difference(P＜0.001). Both groups of patients were followed up for 24 to 36 months, with an average of 28.29±4.70 months. During the follow-up, there was no loosening and breakage of implant, or cage displacement. Classification of cage subsidence: there were 18 cases of grade 0 and 3 cases of grade I in the integrated fixation group, and 25 cases of grade 0 and 0 case of grade I in the combined fixation group, and the difference was statistically significant(P＝0.036). The height of intervertebral space in the two groups recovered significantly after operation, and there were varied degrees of losses in both groups during follow-up. At the final follow-up, the intervertebral height loss in the integrated fixation group was greater than that in the combined fixation group, and the difference was statistically significant(P＝0.046). At the final follow-up, the balance of coronal and sagittal planes of the lumbar vertebrae in the two groups were both recovered well, and there was no statistical difference between groups(P＝0.139, P＝0.149). Both groups achieved good fusion with a fusion rate of 100%. Although the lumbar pain and lumbar function of the two groups recovered significantly at the final follow-up, the integrated fixation group was better than the combined fixation group at three months after operation. During the follow-up, there was no loosening and breakage of implant, or cage displacement. Complications: the incidence rate of the integrated fixation group was 4.76%, and that of the combined fixation group was 8.0%, with no statistical difference(P＝0.082). Conclusions: Under the premise of strict case selection, OLIF combined with integrated plate fixation for the treatment of single-segment lumbar diseases has good early clinical results and is safety, which is obviously superior in the operative time, intraoperative bleeding, and early recovery than OLIF combined with posterior pedicle screw fixation, yet it is recommended to use with caution for the strength of integrated fixation in improving the stability of OLIF fusion segment is limited, the cage subsidence rate is high, and the ability to maintain intervertebral height is poor.