微创极外侧入路腰椎椎间融合术治疗退行性腰椎椎管狭窄症的初步应用和早期疗效分析

Minimally invasive extreme lateral interbody fusionfor degenerative lumbar spinal stenosis—preliminary application and early clinical outcome

目的研究微创极外侧入路腰椎椎间融合术（extreme lateral interbody fusion,XLIF）治疗退行性腰椎椎管狭窄症的早期疗效和安全性。方法 2013年10月~2014年3月本院收治退行性腰椎椎管狭窄症患者14例,均在微创通道下采用XLIF治疗。分别测量并分析术前、末次随访时患者疼痛视觉模拟量表（visual analogue scale,VAS）评分及Oswestry功能障碍指数（Oswestry disability index,ODI）,椎间高度,椎间孔高度,椎间孔面积和盘黄间隙（关节下间隙）,并通过X线片、CT、MRI等影像学资料进行整体评价。结果所有患者手术顺利,术后随访6~13个月,患者均有不同程度的症状改善。5例患者术后出现短暂的右大腿外侧皮肤感觉异常和轻度髂腰肌肌力下降,均在术后2个月内恢复;1例大体重患者术后下床活动时出现持续性腰痛,给予延长卧床休息时间后症状改善。术后影像学显示所有患者椎管及神经根管减压效果满意,滑脱得到一定程度的复位。腰、腿痛VAS评分及ODI均较术前明显改善。术后测量椎间高度增加109.2%;椎间孔高度增加33.8%,症状侧椎间孔面积扩大41.4%,盘黄间隙平均增加2.3 mm。多项影像学评价指标均优于术前,差异有统计学意义（P〈0.01）。结论微创XLIF应用于退行性腰椎椎管狭窄症的治疗,可以使患者早期得到良好的症状缓解和满意的影像学改善,值得临床推广与应用。但其远期疗效还需经过大样本长期的随访和研究。

Objective To observe and evaluate the preliminary clinical outcome and safety of minimally invasive extreme lateral interbody fusion（ XLIF） for degenerative lumbar spinal stenosis. Methods From October 2013 to March 2014,14 patients with diagnosis of degenerative lumbar spinal stenosis were treated with MIS-XLIF surgery. Visual analogue scale（ VAS） scores and Oswestry disability index（ ODI） were observed pre-and post-operatively. Also,the pre-and post-operative measurement of disc height（ DH）,foraminal height（ FH）,foraminal area（ FA）,and disk-flavum ligamentum space（ DFLS） were compared as well as comprehensive evaluation of the radiography,MRI,and CT images. Results All patients were operated successfully. After 6-13 months follow-up,all patients had different degrees of improvement. Five of the patients（ 35. 7%） had a transient paresthesia and mild weekness of muscle unilaterally of the lower limb,however,all of them recovered within 2 months. One case encountered sustained back pain,and alleviated after prolonged rest in bed. The radiographic result showed satisfactory indirect decompression of the neuro-elements,as well as reduction of the lumbar spine.The VAS socres and ODI postoperative both improved compared with the preoperation（ P〈0. 01）. The DH and FH increased by 109. 2% and 33. 8%,respectively. Symptom-side FA enlarged by 41. 4%,The mean DLFS increased by 2. 3 mm（ P〈0. 01）. Conclusion The application of minimally invasive XLIF is effective as well as safe for patients with degenerative lumbar spinal stenosies to obtain well release of symptom and satisfactory radiographic improvement,which deserves clinical promotion and application. However,its long-term effect requires more and longer observations and researches.