斜向腰椎椎间融合术治疗腰椎退行性疾病的临床疗效

Clinical outcomes of oblique lumber interbody fusion in lumbar degenerative disease

目的 :探讨应用斜向腰椎椎间融合术治疗腰椎退行性疾病的临床疗效。方法 :对2015年10月~2016年5月应用斜向腰椎椎间融合术治疗的24例腰椎退行性疾病患者进行回顾性分析,男8例,女16例,年龄44~88岁,平均62.3±12.0岁,手术节段36节。观察手术时间、出血量、术后并发症,比较术前、术后1周、末次随访时腰痛JOA评分、Oswestry功能障碍指数(ODI)情况及X线片上手术节段椎间隙高度(intervertebral disc height,IDH)和椎间孔高度(intervertebral foramen height,IFH)变化。结果 :平均手术时间135±21.0min(100~170min),平均术中出血量163.3±54.9ml(100~300ml)。平均随访时间15.8±2.2个月(13~20个月)。末次随访时7例患者发生融合器下沉,下沉节段10节,其中2例患者未行后路椎弓根螺钉固定,2例患者术中有明确终板损伤;3例出现一过性大腿前方疼痛,1例出现下肢乏力,1周后恢复正常。所有患者症状在随访过程中均逐渐改善,术前、术后1周及末次随访时平均腰痛JOA评分分别为11.2±1.9、19.4±1.3、25.0±0.72,术后1周与末次随访与术前比较均有统计学差异(P<0.01);平均ODI分别为(68.5±5.9)%、(45.6±5.65)%、(12.2±5.1)%,术后1周与末次随访与术前比较均有统计学差异(P<0.01);平均椎间隙高度分别为9.16±2.7mm、12.7±2.6mm、10.8±3.0mm,术后1周与术前比较有统计学差异(P<0.01),末次随访与术前比较无统计学差异(P>0.05);平均椎间孔高度16.9±3.7mm、20.7±3.7mm、18.1±4.2mm,术后1周与术前比较有统计学差异(P<0.01),末次随访与术前比较无统计学差异(P>0.05)。结论:斜向腰椎椎间融合术近期疗效好、安全性高,能有效治疗腰椎退行性疾病,远期疗效还需经过大样本长期的随访和研究。

Objectives： To analyze the clinical outcomes of oblique lumber interbody fusion（OLIF） in treating lumbar degenerative disease. Methods： 24 cases were selected who had lumbar degenerative disease and treated with oblique lumber interbody fusion between October 2015 and May 2016. The operations were per-formed in 36 segments of 8 males and 16 females, with an average age of 62.3±12.0（range, 44-88） years old.Lumbar function was evaluated according to Japanese Orthopaedic Association（JOA） score and Oswestry dis-ability index（ODI）. The intervertebral disc height（IDH） and intervertebral foramen height（IFH） were measured on lumbar plane X-ray before surgery, 1 week after surgery and at final follow-up after operation. The opera-tion time, blood loss and postoperative complication were observed, and then the causes were analyzed. Results： The mean operation time was 135 ±21.0 minutes（100-170 minutes）; and the mean blood loss was163.3±54.9 ml（100-300 ml）. The average follow-up time was 15.8 ±2.2 months（13-20 months）. 7 cases（10 segments） occurred cage subsidence, 2 of them were not placed posterior pedicle screw fixation, and 2 of them had intra-operative end plate damage. 3 cases experienced transient pain in the front of legs and 1 case low-er limbs weakness, but recovered 1 week later. The clinical outcomes of all the patients improved during the follow-up. Before surgery, 1 week after surgery and at final follow-up, the mean JOA scores were 11.2 ±1.9,19.4±1.3, 25.0±0.72, the mean ODI scores were（68.5±5.9）%,（45.6±5.65）%,（12.2±5.1）%, respectively. All the clinical outcomes after surgery improved significantly comparing with those before surgery（P〈0.01）. At the three time points, the mean IDH was 9.16±2.7 mm, 12.7±2.6 mm, 10.8±3.0 mm, the mean IFH was 16.9±3.7 mm,20.7±3.7 mm, 18.1±4.2 mm. The radiographic outcomes at 1 week after surgery improved significantly comparing with those before surgery（P〈0.01）, and the outcomes of final follow-up did not improved significantly comparing with those before surgery（P〈0.05）. Conclusions： Oblique lumber interbody fusion has satisfying and safe short-term outcomes in lumbar degenerative disease. Further follow-up and research is needed to access the long-term outcomes.