斜外侧椎间融合联合多裂肌入路椎弓根钉内固定分期手术治疗老年退行性腰椎管狭窄症

Treatment of elderly degenerative lumbar spinal stenosis with oblique lateral interbody fusion combined with pedicle screw fixation via multifidus intermuscular approach

目的探讨斜外侧椎间融合联合多裂肌入路椎弓根钉内固定分期手术治疗老年退行性腰椎管狭窄症的临床疗效。方法回顾性分析自2017-03—2019-03诊治的28例老年多节段腰椎管狭窄症,一期行斜外侧椎间融合术,二期行多裂肌入路椎弓根钉内固定术,比较术前、术后5 d、术后8周、术后6个月疼痛VAS评分、ODI指数。结果28例均顺利完成手术,随访时间6~18个月,平均12.5个月。一期手术时间65~125 min,平均90 min;术中出血量50~150 m L,平均80 mL。二期手术时间50~85 min,平均60 min;术中出血量40~150 mL,平均60 mL。术后5 d、术后8周、术后6个月疼痛VAS评分、ODI指数较术前均明显降低,差异有统计学意义(P<0.05)。术后6个月按MachNab评分标准评定疗效:优20例,良4例,可1例,优良率96.0%。结论斜外侧椎间融合联合多裂肌入路椎弓根钉内固定分期手术治疗老年退行性腰椎管狭窄症有手术时间短,手术创伤小,术中出血量少等优点,值得临床推广。

Objective To investigate the curative effect of oblique lateral interbody fusion combined with pedicle screw fixation via multifidus intermuscular approach in the treatment of elderly degenerative lumbar spinal stenosis.Methods A retrospective analysis of 28 elderly patients with multilevel lumbar spinal stenosis treated with oblique lateral interbody fusion at the first stage and pedicle screw fixation through multifidus intermuscular approach in the second stage from March 2017 to March 2019 were performed,the pain VAS score and ODI index were compared before operation,5 days after operation,8 weeks after operation,and 6 months after operation.Results All 28 cases completed the operation successfully,and the follow-up time was 6-18 months,with an average of 12.5 months.The first stage operation time was 65-125 min,with an average of 90 min;the intraoperative blood loss was 50-150 mL,with an average of 80 mL;the second stage operation time was 50-85 min,with an average of 60 min;the intraoperative blood loss was 40-150 mL,with an average of 60 mL.Pain VAS score and ODI index were significantly lower at 5 days,8 weeks and 6 months after operation,and the difference was statistically significant(P<0.05).Six months after the operation,the efficacy was evaluated according to the MachNab scoring standard:20 cases were excellent,4 cases were good,and 1 case was fair.The excellent and good rate was 96.0%.Conclusion Oblique lateral interbody fusion combined with pedicle screw fixation via multifidus intermuscular approach in the treatment of elderly degenerative lumbar spinal stenosis has the advantages of short operation time,less trauma and intraoperative blood loss,which is worthy of clinical promotion.