腰大肌前下缘入路斜外侧腰椎间融合的并发症

Complications of anteroinferior psoas oblique lateral lumbar interbody fusion

[目的]研究腰大肌前下缘入路行斜外侧腰椎间融合术(anteroinferior psoasoblique lateral interbody fusion,AIP-OLIF)围手术期并发症发生情况。[方法]回顾性分析2017年4月—2022年8月采用AIP-OLIF治疗的腰椎退行性疾病的143例患者的临床资料,评价并发症情况与随访结果。[结果]患者均顺利完成手术,手术时间平均(238.5±87.7)min,术中出血量平均(104.1±116.4)ml。共39例患者发生并发症,发生率为19.6%。其中术中出现并发症12例(8.4%),包括节段动脉损伤2例、腹膜损伤2例、胸膜损伤2例、硬膜损伤1例、终板损伤5例;术后早期发生并发症12例(8.4%),6例术后第1 d出现左侧大腿前方疼痛、麻木,6例术后出现轻度髂腰肌、股四头肌无力,均于1个月随访时恢复正常。随访时间平均(14.8±4.3)个月,随时间推移,患者VAS评分、ODI评分显著减少(P<0.05),JOA评分显著增加(P<0.05)。15例患者(10.5%)在术后1年复查X线片时发现融合器沉降,均为0级沉降。[结论]AIP-OLIF仍可发生术中和术后并发症,应引起重视。

[Objective]To evaluate the complications of anteroinferior psoasoblique lateral interbody fusion(AIP-OLIF)under direct vision and exposure technique.[Methods]A retrospective study was conducted on 143 patients who received AIP-OLIF from April 2017 to August 2022.The complication and follow-up data were evaluated.[Results]All patients had operation performed successfully with operation time of(238.5±87.7)min,and intraoperative blood loss of(104.1±116.4)ml.Complications in total occurred in 39 patients,accounted for 19.6%.Intraoperative complications occurred in 12 cases(8.4%),including segmental artery injury in 2 cases,peritoneal injury in 2 cases,pleural injury in 2 cases,dural injury in 1 case and endplate injury in 5 cases.Early postoperative complications occurred in 12 patients(8.4%),including 6 patients had pain and numbness in the front of the left thigh on the 1st day after surgery,and 6 patients had mild iliopsoas muscle weakness and quadriceps muscle weakness after surgery,whereas all of them recovered to normal at 1-month follow-up.As time went during follow-up period lasted for(14.8±4.3)months,the VAS score and ODI score were significantly decreased(P<0.05),while JOA score was significantly increased(P<0.05).In 15 patients(10.5%),the fusion device subsidence was found in images one year after the operation,all of which remained grade 0 subsidence.[Conclusion]AIP-OLIF can still cause intraoperative and postoperative complications,which should be paid attention to.