斜外侧腰椎间融合术治疗退变性腰椎病

Oblique lumbar interbody fusion for degenerative lumbar disease

[目的]探讨斜外侧腰椎间融合术(oblique lumbar interbody fusion,OLIF)治疗退行性腰椎疾病的效果.[方法]回顾性分析65例行OLIF治疗的退行性腰椎疾病患者的临床资料,总结OLIF优势、手术适应证及相关并发症.[结果]65例患者均顺利完成手术,术中无血管损伤;手术时间平均(75.14±13.08)min,术中出血量平均(32.11±6.25)ml,手术切口平均(3.12±0.46)cm.术中有1例终板骨折,1例交感神经损伤,经对应处理后,患者不适感均减轻或消失.所有患者随访18~41个月,平均(29.67±13.44)个月,末次随访时患者腰痛和腿痛VAS评分,以及ODI评分均较术前显著降低(P<0.05),而JOA评分较术前显著增加(P<0.05).影像方面,与术前相比,末次随访时患者VIVSH、DIVSH、IFH、SL均显著增加(P<0.05).末次随访无椎弓根螺钉松动、移位或断裂.[结论]OLIF能直接恢复腰椎退行性疾病椎间隙及椎间孔高度,缓解患者临床症状,且安全性高.

[Objective]To evaluate the clinical outcomes of oblique lumbar interbody fusion(OLIF)for treatment of degenerative lumbar diseases.[Methods]A retrospective study was done on 65 patients who underwent OLIF for degenerative lumbar diseases.The advantages,indications and complications of OLIF were summarized.[Results]All the 65 patients had OLIF completed smoothly without serious complications,such as vascular injury,whereas with operative time of(75.14±13.08)min,intraoperative blood loss of(32.11±6.25)ml,and the incision length of(3.12±0.46)cm.During the operation,1 patient got endplate fracture,another got sympathetic nerve injury,which solved by corresponding treatment without serious consequences.The follow up lasted for 18—41 months with a mean of(29.67±13.44)months.At the last follow-up,the VAS scores for low back pain and leg pain,as well as ODI score significantly decreased(P<0.05),while the JOA score significantly increased compared with those preoperatively(P<0.05).In terms of imaging evaluation,the ventral intervertebral space height(VIVSH),dorsal intervertebral space height(DIVSH),intervertebral foramen height(IFH)and segmental lordosis(SL)significantly increased postoperatively compared with those preoperatively(P<0.05).No pedicle screw loosening,displacement or fracture were noted in anyone of them until the time of the latest follow-up.[Conclusion]OLIF does directly restore the height of intervertebral space and foramina in lumbar degenerative diseases,and relieve the clinical symptoms of patients with high safety.