斜外侧入路植入3D打印侧路融合器联合后路经皮钉复位固定治疗腰椎滑脱症

Oblique lateral interbody fusion of 3D printed lateral fusion cage combined with percutaneous pedicle screw fixation for lumbar spondylolisthesis

目的探讨应用后路经皮微创椎弓根置钉撑开复位固定技术联合斜外侧入路椎间融合术(oblique lateral interbody fusion,OLIF)植入3D打印侧路融合器治疗腰椎滑脱症的早期临床疗效。方法选择2018年9月至2020年8月,接受后路经皮微创椎弓根置钉撑开复位固定技术,同时一期联合斜外侧入路植入3D打印侧路融合器行OLIF手术治疗腰椎滑脱症患者21例。记录患者手术时间、术中出血量及并发症的情况;于术前、术后1周和术后6个月进行腰痛及下肢痛的疼痛视觉模拟评分(visual analogue scale,VAS)、Oswestry功能障碍指数(Oswestry disability index,ODI)、健康调查简表(the MOS item short from health survey,SF-36)评估临床疗效;术前、术后1周及术后6个月行CT+三维重建及MRI检查,对比测量和评估椎间隙高度、椎间孔高度、滑移百分比、椎管矢状径和轴向直径及横截面积,椎间融合情况。结果所有患者手术时间平均为(110.0±22.8)min,术中出血量平均为(56.8±21.6)mL。术后6个月均获得随访,腰痛VAS评分、腿痛VAS评分及ODI分别由术前(6.8±1.6)分、(5.6±1.8)分和(57.6±13.4)%下降至随访时(1.5±1.0)分、(1.5±0.9)分和(13.1±5.2)%,差异均有统计学意义(P<0.001);SF-36的生理方面总结(physical component summary,PCS)和精神方面总结(mental component summary,MCS)评分分别由术前(27.3±11.8)分和(52.4±14.6)分上升至随访时(57.6±10.5)分和(76.1±12.0)分,差异均有统计学意义(P<0.001)。患者术后6个月椎间隙高度、椎间孔高度、滑移百分比、椎管矢状径和轴向直径及横截面积较术前对比,差异均有统计学意义(P<0.001)。术后6个月时3D打印椎间融合器上下界面融合率为100%。术后均未出现神经、血管损伤等严重并发症。结论应用后路经皮微创椎弓根置钉撑开复位固定技术联合斜外侧入路椎间融合术(OLIF)植入3D打印侧路融合器治疗腰椎滑脱症的早期临床疗效满意,该项技术可为腰椎滑脱症的微创治疗提供一种全新的选择。

Objective To discuss the early clinical effect of percutaneous pedicle screw fixation combined with oblique lateral interbody fusion(OLIF)of 3D printed lateral fusion cage for lumbar spondylolisthesis.Methods Total 21 patients with lumbar spondylolisthesis were enrolled in our study during September 2018 to August 2020.All the patients were treated with percutaneous pedicle screw fixation combined with OLIF of 3D printed lateral fusion cage.The time of operation,blood loss and complications were recorded.Clinical symptoms including low back pain and leg pain were evaluated using a visual analog scale(VAS),the Oswestry disability index(ODI),and the MOS item short from health survey(SF-36)before,1 week,and 6 months after surgery.CT and MRI images were evaluated before,1 week,and 6 months after surgery.Disk height,interforaminal height,degree of upper vertebral slip and intervertebral fusion were evaluated with CT.Sagittal and axial diameters and cross-sectional areas of the spinal canal were evaluated with MRI.Results The average operation time of all the patients was(110.0±22.8)min,and the average intraoperative blood loss was(56.8±21.6)mL.All the patients were followed up 6 months after operation.The VAS score of lower back pain,VAS score of leg pain and ODI decreased from(6.8±1.6),(5.6±1.8)and(57.6±13.4)% to(1.5±1.0),(1.5±0.9)and(13.1±5.2)%,respectively.The differences were statistically significant(P<0.001).The PCS and MCS scores of SF-36 increased statistically significantly from(27.3±11.8)and(52.4±14.6)before operation to(57.6±10.5)and(76.1±12.0)at follow-up,respectively(P<0.001).Six months after operation,the height of intervertebral space,the height of intervertebral foramen,the percentage of slip,the sagittal diameter and axial diameter,and cross-sectional area of spinal canal were significantly different from those before operation(P<0.001).Six months after operation,the fusion rate of the upper and lower interfaces of the 3D printed interbody fusion cage was 100%.There were no serious complications such as nerve or vascular injury after operation.Conclusion Posterior minimally invasive pedicle screw reduction and fixation technique combined with oblique lateral approach implantation of 3D printing lateral fusion cage in the treatment of lumbar spondylolisthesis has satisfactory early clinical results.This technique can provide a new choice for minimally invasive treatment of lumbar spondylolisthesis.