计算机导航辅助单一体位下斜外侧椎间融合术联合内镜治疗腰椎间盘突出症合并腰椎管狭窄症的初步应用

Preliminary Application of Oblique Lateral Interbody Fusion Combined with Endoscopy in the Treatment of Lumbar Disc Herniation with Lumbar Spinal Stenosis under Computer-assisted Navigation in a Single Position

目的探讨计算机导航辅助下斜外侧椎间融合术(oblique lateral interbody fusion,OLIF)联合内镜减压治疗L5/S1椎间盘突出伴狭窄的临床疗效。方法回顾性分析在我院进行手术治疗的25例L5/S1椎间盘突出伴狭窄病人,其中男9例,女16例;年龄50~79岁,平均65.5岁。采用导航辅助下单一体位内镜直接减压联合OLIF间接减压治疗。观察并记录病人责任椎体间高度、椎间孔高度、椎管的矢状径、疼痛视觉模拟量表(visual analogue scale,VAS)评分、Oswestry功能障碍指数(Oswestry disability index,ODI)、手术失血量、手术时间、下床时间、住院时间、椎间融合率和椎间融合器下沉情况等。结果所有病人随访1年以上,术中均未出现严重并发症;平均手术时间190 min、术中失血量104 m L、下床时间54 h、住院时间10.6 d。术后1年,病人VAS评分、ODI、责任椎体间高度、椎间孔高度、椎管矢状径均较术前明显改善(P<0.05)。术后1年随访期间腰椎CT显示2级以上(完全融合、坚固融合)融合率为92%(23/25),未发生椎间融合器下沉。结论计算机辅助导航下单一体位实现内镜减压联合OLIF治疗L5/S1椎间盘突出症合并椎管狭窄症,初步临床效果满意。

Objective To introduce the surgical technique and initial clinical results of oblique lateral interbody fusion(OLIF)combined with endoscopic decompression under computer-assisted navigation for the treatment of L5/S1 disc herniation with stenosis.Methods A retrospective study was conducted on 25 patients with L5/S1 disc herniation and stenosis who underwent surgical treatment,including 9 males and 16 females;The age range was 50-79 years old,with an average of 65.5 years old.The navigation assisted single position endoscopic direct decompression combined with OLIF indirect decompression treatment was used.The patient's responsible vertebral body height,intervertebral foramen height,sagittal diameter of lumbar vertebral canal,visual analog scale(VAS),Oswestry disability index(ODI),surgical blood loss,surgical time,ambulation time,hospitalization time,and postoperative cage subsidence were observed and recorded.Results All patients were followed up for more than one year,and no serious complications occurred during the operation.The average operation time was 190 min,intraoperative blood loss was 104 mL,ambulation time was 54 h,and hospitalization time was 10.6 d.During the 1-year follow-up,the postoperative VAS for pain,ODI score,height between the responsible vertebral bodies,intervertebral foramen height,and sagittal diameter of the vertebral foramen were significantly improved as compared with those before surgery.Lumbar CT at 1-year follow-up showed a fusion rate of 92%(23/25)at grade 2 or above(complete fusion,solid fusion).No intervertebral cage subsidence occurred.Conclusion The combination of endoscopic decompression and OLIF surgery under computer-assisted navigation in a single position combines the advantages of direct decompression by endoscopy and the minimally invasive fusion by OLIF.This surgical method is effective in the treatment of L5/S1 disc herniation combined with spinal stenosis,and the initial clinical results are satisfactory.