斜外侧椎间融合术治疗腰椎退变性疾病的早期临床效果

Analysis of the early clinical effect of oblique lumbar interbody fusion in the treatment of lumbar degenerative diseases

目的探讨斜外侧椎间融合术(OLIF)治疗腰椎退变性疾病的临床效果。方法收集行OLIF治疗腰椎退变性疾病患者78例,年龄43~74岁,诊断包括腰椎滑脱症23例、腰椎管狭窄症25例、椎间盘源性腰痛21例、成人腰椎侧凸9例。18例行单纯OLIF,40例行OLIF联合单侧椎弓根钉棒内固定,20例行OLIF联合双侧椎弓根钉棒内固定。观察疗效并分析并发症发生情况,分析单纯OLIF或辅助单双侧椎弓根螺钉固定对融合器沉降和椎间融合的影响。结果患者平均手术时间为(77.1±24.8)min,术中平均出血量为(61.3±9.2)mL。平均随访(20±4.6)个月,腰痛VAS评分由术前的(6.1±1.7)分下降至末次随访时的(1.3±0.3)分,ODI评分由术前的(51.3±8.2)%下降至末次随访时的(15.2±3.7)%。所有患者X线和MRI影像学指标均得到明显改善,术后1年整体椎间融合率为96.2%,发生各类并发症共13例,总发生率为16.7%。术后随访发现Cage沉降5例,行翻修手术后症状缓解。结论OLIF在治疗腰椎退变性疾病方面具有良好的早期临床效果,是一种安全有效的微创手术方式,单纯OLIF手术Cage沉降的发生率明显高于后路内固定组,OLIF联合后路单侧椎弓根钉棒固定和联合双侧椎弓根钉棒固定对椎间融合和融合器下沉影响差别不大。

Objective To investigate the clinical effect of oblique lateral interbody fusion(OLIF)in the treatment of lumbar degenerative diseases.Methods 78 patients with lumbar degenerative diseases were treated with OLIF,including 35 males and 43 females with an average age of(57.6±6.8).The diagnosis included 23 cases of lumbar spondylolisthesis,25 cases of lumbar spinal stenosis,21 cases of discogenic low back pain,9 cases of adult lumbar scoliosis and 18 cases of simple OLIF.40 cases underwent OLIF combined with posterior unilateral pedicle screw fixation and 20 cases underwent posterior bilateral pedicle screw fixation.The clinical data of the patients were collected,and the curative effect was observed and the complications were analyzed.The effects of simple OLIF or unilateral and bilateral pedicle screw fixation on cage subsidence and interbody fusion were analyzed.Results The average operation time was(77.1±24.8)min and the average intraoperative bleeding was(61.3±9.2)mL.After an average follow-up of(20±4.6)months,the VAS score of low back pain decreased from(6.1±1.7)to(1.3±0.3)at the last follow-up,and the ODI score decreased from(51.3±8.2)%before operation to(15.2±3.7)at the last follow-up.The X-ray and MRI imaging indexes of all patients were significantly improved.The overall interbody fusion rate was 96.2%one year after operation,There were 13 cases of various complications,and the total incidence was 16.7%.Postoperative follow-up showed that 5 cases of cage settlement were relieved after revision surgery.Conclusion OLIF has a good clinical effect in the treatment of lumbar degenerative diseases,and it is a safe and effective minimally invasive operation.The incidence of cage settlement in OLIF group is significantly higher than that in posterior internal fixation group.Olif combined with posterior unilateral pedicle screw rod fixation and combined with bilateral pedicle screw rod fixation have little effect on intervertebral fusion and cage settlement.