斜外侧腰椎椎间融合术治疗轻中度腰椎管狭窄症的近期疗效

Short-term clinical of oblique lateral interbody fusion in the treatment of mild-to- moderate of degenerative lumbar spinal stenosis

中文关键词:  腰椎管狭窄症  斜外侧腰椎椎间融合术  近期疗效

英文关键词:Lumbar spinal stenosis  Oblique lateral lumbar interbody fusion  Short-term effects

中文摘要:

  【摘要】 目的：探讨斜外侧腰椎椎间融合术（oblique lateral interboy fusion，OLIF）治疗轻中度腰椎管狭窄症的近期疗效。方法：回顾性分析我院2018年5月~2020年5月应用OLIF治疗的35例轻中度腰椎管狭窄症患者，其中男25例，女10例，年龄50~74（60.3±10.7）岁，随访12~28（18.3±3.7）个月，记录手术时间、术中出血量及并发症的情况；比较术前和术后1周、术后3个月、6个月、12个月时的腰痛和下肢痛疼痛视觉模拟评分（visual analogue scale，VAS）、Oswestry功能障碍指数（Oswestry disability index，ODI）；同期行腰椎X线、CT及MRI检查，测量手术节段椎间隙高度、椎间孔大小（左、右）、硬膜囊面积和矢状径、椎间隙前凸角、腰椎前凸角等影像指标，统计分析比较术前与术后各时间点以及术后各时间点之间的差异，记录并发症及各随访时间点的椎间融合情况。结果：所有患者手术顺利，手术时间30~100min（70.5±20.3min），术中出血量20~120mL（60.3±20.2mL）。术后1周、3个月、6个月、12个月腰痛VAS评分、下肢痛VAS评分及ODI较术前明显改善，差异均有统计学意义（P<0.05），术后各时间点两两比较无统计学意义（P>0.05）；术后1周、术后3个月、6个月、12个月椎间隙高度、椎间隙前凸角及腰椎前凸角、椎间孔大小（左、右）、硬膜囊面积和矢状径较术前明显增大，差异均有统计学意义（P<0.05），术后各时间点两两比较无统计学差异（P>0.05）。术后1年时CT评估融合率为94.2%（33/35例）。术中未出现神经、血管损伤等严重并发症，术后出现屈髋乏力及大腿前方麻木3例，经保守治疗对症处理1个月后缓解；终板切割融合器下沉2例，均二期翻修行后路肌间隙入路内固定术。结论：OLIF治疗轻中度腰椎管狭窄症的近期疗效满意。

英文摘要:

  【Abstract】 Objectives: To investigate the short-term efficacy of oblique lateral interbody fusion(OLIF) in treating mild-to-moderate lumbar spinal stenosis(LSS). Methods: 35 patients with mild-to-moderate LSS treated with OLIF between May 2018 and May 2020 were analyzed retrospectively, including 25 males and 10 females, aged 50-74(60.3±10.7) years old. The patients were followed up for 12-28(18.3±3.7) months. The operative time, intraoperative bleeding, and complications were recorded; At preoperation, 1 week, and 3, 6 and 12 months after surgery, the visual analogue scale(VAS) for lumbar and leg pain and Oswestry disability index(ODI) were compared to evaluate clinical efficacy; And lumbar X-ray, CT, and MRI were performed at the same time to measure and evaluate the height of the intervertebral space, size of intervertebral foramen, area of dural sac and sagittal diameter, lordotic angle of intervertebral space, lordotic angle of lumbar spine, and their respective differences between before and after operation, as well as between each postoperative time point were analyzed; The complications and fusion conditions at each time point were also documented. Results: The operative time was 30-100(70.5±20.3)min, and intraoperative bleeding was 20-120(60.3±20.2)mL. The lumbar and leg pain VAS scores and ODI at postoperative 1 week, and 3, 6 and 12 months were significantly improved compared with those before operation, and the differences were statistically significant(P＜0.05), while there was no statistical significance when compared pairwisely between postoperative time points(P＞0.05). At postoperative 1 week, and 3, 6 and 12 months, the intervertebral space height, intervertebral lordotic angle and lumbar lordotic angle, left and right intervertebral foramina sizes, dural sac areas, and sagittal diameters increased significantly compared with those before operation, with statistically significance(P＜0.05), and no statistical difference was found when compared pairwisely between postoperative time points for each imaging parameter(P>0.05). According to the CT image evaluation 1 year after operation, the overall fusion rate was 94.2%(33/35 cases). No serious complications such as nerve and vascular injury occurred; 3 cases of postoperative hip flexion weakness and anterior thigh numbness were relieved after 1 month of symptomatic treatment with conservative therapy; 2 cases of fusion device sinking of end-plate cutting were revised in the second stage and underwent posterior muscular gap approach internal fixation. Conclusions: OLIF has satisfactory short-term clinical efficacy in the treatment of mild-to-moderate LSS.