斜外侧腰椎间融合术并发症研究进展

The complications of oblique lateral interbody fusion procedure

斜外侧腰椎间融合术(oblique lumbar interbody fusion,OLIF)是一种经腹膜后腰大肌前缘与大血管间隙的操作窗(anterior to psoas,ATP)行腰椎间融合(lumbar interbody fusion,LIF)的小切口微创手术。OLIF手术虽然较其他入路手术有诸多优势,但也存在各类手术相关并发症,发生率为3.69%~81.82%。大部分并发症经过保守或对症处理可自行缓解,只有较少的并发症难以恢复,需要翻修手术治疗,甚至产生后遗症。OLIF并发症包括术中并发症和术后并发症。血管损伤是术中危险性较大的并发症,需要即刻压迫或缝合止血;神经损伤可以通过避免暴力牵拉和分离组织,减少手术时间等方法降低其发生率,胸腹膜损伤发生时,应尽量术中即刻缝合。一过性髋关节屈曲无力和一过性大腿/腹股沟感觉障碍是最常见的术后并发症,数月后大多可自行消失。肠梗阻由于术中对腹膜牵拉导致,多为不完全性,可自行缓解。术后感染大多为浅表性,经过换药和应用抗生素可治愈。Cage下沉、椎间隙塌陷是最常见融合器或假体相关并发,可无相关临床症状,但严重者需要翻修手术治疗。假关节形成发生率较低,少数伴临床症状者需要翻修手术治疗。对于OLIF并发症的研究大多样本量较小,随访时间较短,所以将来还需要更多的大样本、多中心的研究来完善我们对OLIF并发症的认识。

Oblique lateral interbody fusion(OLIF)was minimally invasiveprocedure for lumbar interbody fusion(LIF)through the space between anterior margin of retroperitoneal psoas major muscle and the vessels(ATP).Although OLIF had many advantages over other approaches,there were also various kinds of surgical complications,the incidence of which was 3.69%-81.82%.Most of the complications were relieved by conservative or symptomatic treatment.Only a small number of complications were difficult to recover,if so,revision surgery was needed and might remain persistent symptoms.OLIF complications included intraoperative and postoperative complications.Major vascular injury was a dangerous complication during operation,which requires immediate compression or suture to prevent bleeding.The incidence of nerve injury could be reduced by avoiding violent traction and tissue separation and reducing the operation time.When injury of thorax and peritoneum occurs,suture should be done as soon as possible.Transient hip flexion weakness and transient thigh/groin sensory disturbance was the most common post-operative complication,most of which would disappear after several months.Intestinal obstruction is caused by the pulling of peritoneum during operation,most of which was incomplete and would be relieved after some time.Postoperative infection was mostly superficial and would be cured by dressing change and antibiotic application.Subsidence of cage and collapse of intervertebral space were the most common complications related to instrumentations which might not lead to related clinical symptoms;however the severe cases need to be repaired.The incidence of pseudarthrosis is relatively low and a few patients with clinical symptoms need revision surgery.The sample size of most studies was small and follow-up period was short.In the future,large samples and multi-center studies are needed to improve our understanding of OLIF complications in the future.