斜外侧腰椎椎间融合术间接减压治疗退行性腰椎管狭窄症的早期疗效

Short-term clinical outcome and radiographic assessment of indirectly decompression of oblique lateral interbody fusion for degenerative lumbar spinal stenosis

目的探讨斜外侧腰椎椎间融合术（oblique Lateral Interbody Fusion，OLIF）间接减压治疗退行性腰椎管狭窄症伴或不伴腰椎不稳患者的早期临床疗效。方法回顾性分析2014年07月至2015年12月采用OLIF技术治疗15例退变性腰椎管狭窄症伴或不伴腰椎不稳患者的病历资料，男7例，女8例；年龄36~86岁，平均（53．5＋15．2）岁。主要症状表现为腰痛伴下肢根性疼痛或间歇性跛行。临床疗效评价采用疼痛视觉模拟评分（visual analoguescale，VAS）、Oswestry功能障碍指数（Oswestry disability index，ODI）、日本骨科协会（Japanese Orthopaedic Association Scores，JOA）评分和健康调查简表（the MOS item short from health survey，SF-36）；测量手术前后椎间隙高度、椎管内径、椎间孔高度、椎间孔面积、椎管面积和盘黄间隙等影像学参数评价影像学疗效。结果术后患者均获得随访，随访时间为6~21个月，平均12．5个月。术后腰痛、腿痛VAS评分、ODI、JOA评分及SF-36评分均较术前明显改善；影像学测量结果显示术后手术节段椎间隙背侧高度增加了3．6mm、椎间隙腹侧高度增加了4．8mm，椎间孔高度增加了5．7mm，椎间孔面积增加了44．2mm^2，椎管内径增加了2．55mm，椎管面积增加了24．8mm^2，盘黄间隙增加了2mm，手术前后的差异均有统计学意义；椎间孔横径增加了0．3mm，但差异无统计学意义。术后手术节段前凸角和腰椎前凸角均得到部分恢复，分别增加了14．0°与13．6°。术后出现屈髋乏力及大腿前侧麻木各l例，对症处理后于术后3个月症状缓解；1例术后1个月发生腰痛加重，再次行后路固定手术。结论OLIF手术治疗退行性腰椎椎管狭窄症可以增加椎间隙高度、椎间孔上下径、椎管直径、盘黄间隙距离及恢复腰椎前凸，达到中央管及椎间孔狭窄间接减压的目的，早期临床疗效满意。

Objective To investigate the short-term clinical outcome and radiographic assessment of Oblique Lateral In- terbody Fusion to indirectly decompress for the degenerative lumbar spinal stenosis with or without lumbar spine instability. Meth- ods All of 15 patients with diagnosis of degenerative lumbar spinal stenosis with or without lumbar spine instability （7 males and 8 females, age from 36y to 86, mean age 53.5±15.2 y） were treated with OLIF surgery in our spine surgery center. The main symptoms included lumbar pain with unilateral or bilateral leg pain or intermittent claudication. The Visual analogue scale （VAS）, Oswestry disability index （ODI）, Japanese Orthopaedic Association （JOA） and SF-36 scores were used to assess the clinical effect pre and post-operatively while radiographic assessments were compared as well as comprehensive evaluation of the radiography, MRI, and CT images. Results All patients were followed up for an average of 12.5 （6-21） months. And all the patients enjoyed alleviation of symptoms although varying in extent. The radiographic results showed satisfactory indirect decompression of the neu- ro-elements, as well as reduction of the lumbar spine. The DH, VII and FH increased by 3.6mm, 4.Smm and 5.7mm respectively. The foraminal area （FA） and canal area （CA） enlarged by 44.2mm^2 and 24.8mm^2. The canal diameters （CD） and disk-flavum liga- mentum space （DLFS） increased by 2.Smm and 2mm respectively. The foraminal diameters （FD） increased by 0.3mm, but there was not significantly different. The segment angle and lumbar lordosis angle were partially restored after operation, and the angle increased by 14° and 13.6 °respectively. One of the patients had a transient paresthesia and mild weakness of muscle when hip flexor and recovered within 3 months. Another one case encountered serious back pain after a month and alleviated after reopera- tion with PPF. Conclusion OLIF can provide a satisfactory outcome for the patients with degenerative lumbar spinal stenosis through indirectly decompression, which can increase the disc height, foramen height, canal diameter and disk-flavum ligamentum space.