Pivox固定系统在斜外侧腰椎椎间融合术治疗单节段腰椎疾患中的临床应用

Clinical application of the Pivox system during oblique lateral interbody fusion(OLIF) in the treatment of single-segment lumbar spine diseases

中文关键词:  Pivox  斜外侧腰椎椎间融合术  融合器沉降  融合器移位

英文关键词:Pivox  Oblique lateral interbody fusion  Cage subsidence  Cage displacement

中文摘要:

  【摘要】 目的：探讨Pivox固定系统在斜外侧腰椎椎间融合术（oblique lateral interbody fusion，OLIF）治疗单节段腰椎疾患中的应用及临床疗效。方法：自2020年5月～2021年1月，收集我院采用单纯OLIF（不行后路椎弓根螺钉固定技术）治疗单节段腰椎疾患（盘源性腰痛、腰椎滑脱、腰椎管狭窄）的患者资料，其中男36例，女33例；年龄32～79岁，平均59.1±5.9岁。分为单纯OLIF组（39例）和Pivox+OLIF组（30例），评估两组的围手术期指标：包括切口长度，手术时间，术中出血量，住院时间；在术前、术后1周、1个月、3个月、6个月、12个月时用疼痛视觉模拟评分（visual analogue scale，VAS）和Oswestry功能障碍指数（Oswestry disability index，ODI）对两组临床疗效进行评价，评估并比较两组患者手术前后的椎间隙高度、椎间孔纵径和面积以及术后腰椎融合情况。以及比较两组之间并发症情况。结果：所有患者随访12～18个月，平均14.0±0.3个月，两组之间性别、年龄、疾病类型、手术节段、骨密度、体质指数（body mass index，BMI）等方面比较差异均无统计学意义（P>0.05）。Pivox+OLIF组手术时间大于OLIF组（P<0.05），而两组之间切口长度、出院时间、术中出血量无统计学差异（P>0.05）。两组组内围手术期VAS评分、ODI比较均为术前高于术后1周及术后1、3、6、12个月（P<0.05），术后1周及术后1、3、6、12个月时，两组之间VAS评分、ODI比较无统计学差异（P>0.05）。两组组内椎间隙高度、椎间孔纵径和面积术后1周及术后6、12个月较术前均明显增加（P<0.05），术后1周及术后6、12个月时，Pivox+OLIF组椎间隙、椎间孔纵径和面积增加值均大于OLIF组，但无统计学差异（P>0.05）。两组均有融合器沉降病例，OLIF组有两例发生融合器移位，Pivox+OLIF组无一例融合器移位，两组之间融合率和并发症发生率无明显差异（P>0.05）。结论：Pivox+OLIF技术治疗单节段腰椎退行性疾病的近期疗效满意，但相对于单纯OLIF，Pivox+OLIF在椎管减压以及融合器下沉方面并无明显优势。

英文摘要:

  【Abstract】 Objectives: To explore the clinical use and observe the clinical efficacy of the Pivox system in oblique lateral interbody fusion(OLIF) in treating single-segment lumbar spinal diseases. Methods: The clinical data of patients with single-segment lumbar spinal diseases(Discogenic low back pain, lumbar spondylolisthesis, lumbar spinal stenosis) who underwent OLIF without posterior instrumentation from May 2020 to January 2021 in our hospital were collected, including 36 males and 33 females, aged 32-79 years old(59.1±5.9 years). And the patients were divided into OLIF stand-alone group(39 patients) and Pivox+OLIF group(30 patients). The perioperative parameters of the two groups of patients were compared, including incision length, operative time, intraoperative blood loss, and length of hospital stay. The visual analogue scale(VAS) and Oswestry disability index(ODI) were assessed before operation, at 1 week, 1, 3, 6 and 12 months after operation for clinical efficacy. The intervertebral disc height, foraminal height and foraminal area before and after operation, and the fusion rate were evaluated and compared between the two groups. Complications were recorded and compared as well. Results: The patients were followed up for 14.0±0.3 months(12-18 months). No significant differences were found between the two groups in gender, age, disease type, operative level, bone mineral density(BMD), or body mass index(BMI)(P>0.05). The operative time in OLIF group was shorter than that in Pivox+OLIF group(P<0.05), while there were no significant differences in blood loss, incision length and hospital stay(P>0.05). The VAS score and ODI index in both groups before surgery were higher than those at 1 week, 1 month, 3 months, 6 months, and 12 months after surgery(P<0.05). No significant differences in VAS and ODI were found at 1 week, 1 month, 3 months, 6 months, and 12 months after surgery between the two groups, respectively(P>0.05). The intervertebral disc height, foraminal height and foraminal area at postoperative 1 week, 6 and 12 months were all greater than those before operation in both groups, while the increase values of intervertebral disc height, foraminal height and foraminal area in Pivox+OLIF group were greater than those in OLIF group at 1 week, and 6 and 12 months after surgery, but without statistical differences(P>0.05). Cage subsidence occurred in both groups, and cage displacement was noticed in two cases in the OLIF group, while none was there in the Pivox+OLIF group. There were no significant differences in fusion rate and incidence of complications between two groups(P>0.05). Conclusions: The short-term effect of Pivox+OLIF procedure in the treatment of single-segment lumbar degenerative diseases is satisfactory, but comparing with stand-alone OLIF, Pivox+OLIF has no obvious advantage in spinal canal decompression and preventing cage subsidence.