微创侧(前)方入路腰椎椎间融合术(XLIF＆OLIF)治疗退变性脊柱侧凸

Management of degenerative scoliosis by minimally invasive lateral/oblique lumbar interbody fusion(XLIF&OLIF)

目的观察运用微创侧(前)方入路腰椎椎间融合术(XLIF&OLIF)治疗退变性脊柱侧凸的临床疗效。方法回顾性分析2013-04-2016-04采用侧(前)方入路腰椎椎间融合术(XLIF&OLIF)治疗的21例退变性脊柱侧凸患者资料,男9例、女12例,平均年龄51.7岁(37~75岁);比较手术前后Oswestry功能障碍评分(Oswestry Disability Index,ODI)、疼痛视觉模拟评分(Visual Analog Scale,VAS)、Cobb角,手术时间、出血量、手术并发症,并进行疗效评定。结果 21例患者获得6~36个月(平均25.7月)随访,术前与末次随访比较,Cobb角从(25.2±14.5)°下降至(17.9±6.6)°,ODI评分从(56.1±46.9)%降至(22.3±23.6)%,VAS评分从(6.8±5.5)分降至(2.8±1.3)分,差异均有统计学意义(P<0.05)。末次随访时按照改良的Mac Nab标准,优15例,良4例,中2例,差0例,优良率达到90.47%。并发症方面:术后3例出现一过性大腿前侧疼痛或麻木。结论微创侧(前)方入路腰椎椎间融合术(XLIF&OLIF)治疗退变性脊柱侧凸可取得良好的近期手术疗效,创伤小、并发症少。

Objective To evaluate the efficacy of lateral/oblique lumbar interbody fusion （XLIF＆OLIF）in the treatment of degenerative scoliosis. Methods From April 2013 to April 2016, 21 patients with degenerative scoliosis were treated by XLIF or OLIF. There were 9 men and 12 women, aged from 37 to 75 years old（average 51.7 years）. Oswestry disability index（ODI）, Visual Analog Scale（VAS） and Cobb＇s angle were compared between preoperation and the last follow-up. Comphcations were recorded and outcomes were evaluated. Results Follow-up for 6 ~ 36 months revealed that the mean Cobb＇s angle decreased from preoperation （25.2 ± 14.5）° to postoperation （17.9 ± 6.6）° the mean ODI score from preoperation （56.1 ± 46.9）% to postoperation（22.3 ± 23.6 ）%, and the mean VAS score from preoperation （6.8 ± 5.5） to postoperation （2.8 ± 1.3 ）°, the differences were statistically significant （p 〈 0.05 ）. By the modified MacNab＇s standard, 15 cases were rated as excellent, 4 cases as good, 2 cases fair and none as bad, the excellent and good rate was 90.47 %. The postoperative complications included anterior femoral pain or paralysis in 3 cases. Conclusions Minimally invasive lateral/oblique lumbar interbody fusion techniques such as XLIF and OLIF are effective for treating degenerative scoliosis, and can get satisfactory recent surgical effect with minimal trauma and low complication rate.