斜外侧腰椎椎间融合术联合后路导航长节段内固定治疗退行性脊柱侧凸

Treatment of degenerative scoliosis with oblique lateral lumbar interbody fusion combined with long-segment internal fixation through navigation for posterior

目的:观察斜外侧腰椎椎间融合术(oblique lumbar interbody fusion,OLIF)联合后路O形臂CT导航长节段内固定治疗退行性脊柱侧凸的早期临床疗效。方法:对2016年4月至2017年12月接受OLIF联合后路O形臂CT导航长节段内固定手术治疗的15例退行性脊柱侧凸患者进行回顾性分析,其中男3例,女12例;年龄55~73(62.2±5.3)岁。记录患者手术时间、术中出血量、术中椎弓根螺钉优良率及并发症情况;于术前、术后1周及末次随访时采用疼痛视觉模拟评分(visual analogue scale,VAS)和Oswestry功能障碍指数(Oswestry Disability Index,ODI)分别对患者的临床症状进行评估;同期行脊柱全长站立位X线片,术后6个月行腰椎CT检查,观察冠状位侧凸Cobb角,腰椎前凸角(lumbar lordosis,LL),椎间隙高度,矢状面平衡(sagittal vertical axis,SVA),椎间融合等情况。结果:患者OLIF手术时间(98.7±16.8)min,术中出血量(50.2±10.7)ml。后路O形臂CT导航长节段内固定手术时间(101.5±23.4)min,术中出血量(63.1±19.7)ml。总手术时间(200.2±40.2)min,术中出血量(113.3±30.4)ml。术后15例患者均获随访,时间12~25(16.5±5.3)个月。腰痛VAS评分、下肢痛VAS评分及ODI分别由术前的(6.8±1.6)分、(6.2±1.1)分和(64.6±10.4)%降低至末次随访时的(1.4±1.0)分、(1.0±0.5)分和(15.8±4.5)%,差异均有统计学意义(P<0.05)。冠状位侧凸Cobb角和SVA分别由术前的(20.3±13.5)°、(42.3±16.5)mm降低至末次随访时的(5.5±3.1)°、(25.1±10.9)mm,差异均有统计学意义(P<0.05)。LL和椎间隙高度由术前的(25.8±8.2)°、(5.9±2.7)mm提升至末次随访时的(39.3±9.1)°、(10.9±1.2)mm,差异均有统计学意义(P<0.05)。O形臂CT导航置钉240枚,术中O形臂三维扫描优良率为96%(230/240)。术后6个月腰椎CT显示椎间融合器均骨性融合。1例患者术后出现左大腿前内侧疼痛,2例患者术后出现短暂的左侧屈髋无力,均在随后的随访中恢复。结论:斜外侧腰椎椎间融合术联合后路O形臂CT导航长节段内固定治疗退行性脊柱侧凸的早期临床疗效满意,具有微创、导航置钉准确、骨融合率高及并发症少等优点,可为退行性脊柱侧凸的微创治疗提供新的选择。

Objective:To assess the early clinical effects of oblique lateral lumbar interbody fusion(OLIF) combined with posterior long-segment internal fixation through O-arm CT navigation for the treatment of degenerative scoliosis.Methods:The clinical data of 15 patients with degenerative scoliosis treated by OLIF combined with posterior long-segment internal fixation through O-arm CT navigation between April 2016 and December were retropectively analyzed.There were 3 males and 12 females,aged from 55 to 73 years old with an average of(62.2±5.3) years.The operation time,intraoperation blood loss,the rate of excellent and good of pedicle screw placement,and complications were recorded.Before surgery,1 week after surgery and at the final follow-up,the visual analogue scale(VAS) and Oswestry Disability Index(ODI) were used to evaluate the patients’ clinical symptoms;standing X-ray film,lumbar spine CT examination was performed at 6 months after surgery to observe coronal scoliosis Cobb angle,lumbar lordosis(LL),intervertebral space height,sagittal vertical axis(SVA),intervertebral fusion,etc.Results:The mean operation time and intraoperative blood loss were respectively(98.7±16.8) min and(50.2±10.7) ml in OLIF surgery,while were(101.5±23.4) min and(63.1±19.7) ml in the surgery of posterior long-segment internal fixation.The total mean operation time and intraoperative blood loss were(200.2±40.2) min and(113.3±30.4) ml.All patients were followed from 12 to 25 months with an average of(16.5±5.3) months.Low back pain VAS,lower limb pain VAS and ODI reduced from preoperative(6.8±1.6),(6.2±1.1) scores and(64.6±10.4)% to(1.4±1.0),(1.0±0.5) scores,and(15.8±4.5)% at the final follow-up,the differences were statistically significant(P<0.05).C.oronal scoliosis Cobb angle and SVA decreased from preoperative(20.3±13.5)°,(42.3±16.5) mm to(5.5±3.1)°,(25.1±10.9) mm at the final follow-up,and the differences were statistically significant(P<0.05).LL and intervertebral space height increased from preoperative(25.8±8.2).,(5.9±2.7) mm to(39.3±9.1)°,(10.9±1.2) at the final follow-up,and the differences were statistically significant(P<0.05).Total 240 nails were placed through O-arm CT navigation with the rate of excellent and good of 96%(230/240).Six months after operation,CT of lumbar spine showed interbody fusion of bone.One patient developed anterior medial pain in the left thigh,and two patients experienced transient left hip flexion after surgery,both of whom recovered during subsequent follow-up.Conclusion:The early clinical effect of oblique lateral lumbar interbody fusion combined with posterior long segment internal fixation through O-arm CT navigation is satisfactory in treatment of degenerative scoliosis.It has the advantages of minimal invasion,accurate navigation of nail placement,high bone fusion rate and few complications.It can provide new options for minimally invasive treatment of degenerative scoliosis.