腰椎退行性病单独腰椎斜外侧椎体间融合术的并发症

Complications of stand-alone oblique lateral interbody fusion(OLIF) for lumbar degenerative diseases

[目的]探究单独腰椎斜外侧入路椎体间融合术(单独OLIF)的早期并发症。[方法]回顾性研究自2017年8月~2018年12月在本院应用单独OLIF技术治疗腰椎退行性疾病96例患者,男44例,女52例;年龄33岁-86岁。记录术中和术后并发症,采用视觉模拟疼痛评分(VAS)、Oswestry功能障碍指数(ODI)评价临床疗效,行影像学检查以确定内置物位置、终板损伤和对侧神经根等情况。[结果]96例患者共进行了137个节段的单独OLIF手术,手术时间平均(94.10±25.95)min,术中平均出血量(48.41±9.97)ml,术后平均住院天数(6.01±2.51)d。所有患者术中术后均未输血。术中共发生血管损伤2例,终板损伤3例,腹膜损伤1例,术中及时处理,术后恢复良好,无不良后果;30例患者出现术后并发症,并发症发生率为31.25%,其中4例患者出现了两种并发症。术后并发症包括交感神经损伤2例,对侧神经根损伤2例,股四头肌无力3例,髂腰肌无力1例,大腿前外侧疼痛3例,融合器下沉15例,融合器移位1例,融合节段椎体骨折2例,腹壁皮下积气1例。经相应处理,以上并发症均未导致严重不良后果。术后所有患者腰腿疼痛明显减轻,下肢功能明显好转。末次随访时,96例患者的腰痛、腿痛VAS评分和ODI评分均较术前显著下降,差异具有统计学意义(P<0.05)。[结论]单独OLIF技术仍在发展的早期,手术并发症需要引起高度关注,但短期随访的结果是令人满意的。

[Objective]To investigate complications of stand-alone oblique lateral interbody fusion(OLIF)for lumbar degenerative diseases.[Methods]From August 2017 to December 2018,a retrospective study was conducted on 96 patients who underwent stand-alone OLIF,including 44 males and 52 females aged 33~86 years.All the complications intraoperatively and postoperatively were recorded.Clinical outcomes were evaluated using visual analogue scale(VAS)and Oswestry disability index(ODI).Radiographic examinations were used to determine the location of cage,endplate damage and contralateral nerve roots.[Results]All the 96 patients received stand-alone OLIF involving 137 segments,with operation time of(94.10±25.95)min,intraoperative blood loss of(48.41±9.97)ml and hospital stay of(6.01±2.51)days,whereas no blood transfusion in anyone of them perioperatively.Complications were noticed in 30 patients including 4 patients with 2 complications,associated with incidence of 31.25%.During operation,vascular injury in 2 cases,endplate injury in 3 cases and peritoneal injury in 1 case were found and managed properly on time without serious consequences.However,postoperative complications,involving sympathetic nerve injury in 2,contralateral nerve root injury in 2,quadriceps weakness in 3,iliopsoas weakness in 1,anterolateral thigh pain in 3,cage subsidence in 15,cage displacement in 1,involved vertebral body fracture in 2 and abdomen subcutaneous pneumatosis in 1 case were noticed.After corresponding treatments for these complications,no serious adverse consequences remained.As time went postoperatively,the symptoms,such as low back pain and leg pain,relieved,and function improved gradually in all the 96 patients.At the latest follow up the VAS and ODI scores significantly decreased compared with those before operation,which proved statistically significant(P<0.05).[Conclusion]The short-term clinical outcomes of stand-alone OLIF are satisfactory for lumbar degenerative diseases,however high attention should be paid to the complications,especially at early stage to apply this technique.