斜外侧腰椎椎间融合术治疗单节段腰椎结核的早期临床疗效

Early Clinical Efficacy of Oblique Lateral Interbody Fusion Combined with Lateral Vertebral Body Screw Fixation for the Treatment of Single-segment Lumbar Tuberculosis

目的探讨斜外侧腰椎椎间融合术(OLIF)联合侧方椎体螺钉固定治疗单节段腰椎结核的安全性及早期临床疗效。方法回顾性分析我院2018年1月~2020年11月应用OLIF联合侧方椎体螺钉固定治疗的单节段腰椎结核病人临床资料,其中男14例,女11例,年龄(50.0±11.8)岁(26~64岁)。记录手术时间、术中出血量、住院时长及并发症评价手术安全性;记录病人术前、末次随访的疼痛视觉模拟量表(VAS)评分、Oswestry功能障碍指数(ODI)以评估神经功能及其临床症状改善程度;记录白细胞(WBC)、C-反应蛋白(CRP)、红细胞沉降率(ESR)等炎症指标评价脊柱结核活动性及复发率;测量骨盆投射角(PI)、骨盆倾斜度(PT)、骶骨倾斜角(SS)、椎间盘高度(DH)、矢状面Cobb角等影像学参数观察腰椎稳定性及椎间植骨融合情况。结果所有病人均顺利完成手术,手术时间(92.8±12.4)min,术中出血量(108.5±32.9)mL;住院时间(13.6±2.1)天,随访时间(14.1±2.0)个月。病人VAS评分、ODI、WBC、CRP、ESR在术后即刻、1个月、3个月、6个月随访时均较术前降低,差异有统计学意义(P<0.05);在术后即刻、1个月、3个月、6个月随访时,DH较术前显著增大,PI、PT、Cobb角较术前显著降低,差异有统计学意义(P<0.05)。所有病人末次随访时均达到了骨性融合,未出现手术相关并发症。结论OLIF联合侧方椎体螺钉固定技术治疗单节段腰椎结核感染可以取得良好的临床疗效及影像学结果。

Objective To explore the safety and early clinical efficacy of oblique lateral interbody fusion(OLIF)combined with lateral vertebral body screw fixation for the treatment of single-segment lumbar tuberculosis.Methods A retrospective study was conducted on the clinical data of patients with single segment lumbar tuberculosis who were treated with OLIF combined with lateral vertebral screw fixation in our hospital from January 2018 to November 2020.There were 14 males and 11 females,aged(50.0±11.8)years(2678 years).The operation time,intraoperative blood loss,postoperative hospital stays and complications were recorded to evaluate the safety of the operation.The visual analogue scale(VAS),Oswestry disability index(ODI)before surgery and at last follow-up were recorded to evaluate neurological function and the degree of improvement in clinical symptoms.The inflammatory indicators such as white blood cells(WBC)count,Creactive protein(CRP)and erythrocyte sedimentation rate(ESR)were recorded to evaluate the activity and recurrence rate of spinal tuberculosis.The pelvic incidence(PI),pelvic tilt(PT),sacral slope(SS),disc height(DH),sagittal Cobb angle and other imaging parameters were used to observe the stability of the lumbar spine and the fusion of intervertebral bone grafts.Results The operations were successfully completed in all patients.The operation time was(92.8±12.4)min,and the intraoperative blood loss was(108.5±32.9)mL.The hospital stay was(13.6±2.1)days,and the follow-up during was(14.1±2.0)months.The VAS scores,ODI,WBC count,CRP and ESR of the patients immediate,1st month,3rd month,and 6th month postoperation,and at the last follow-up were lower than those before operation,and the difference was statistically significant(P<0.05).Immediate,1st month,3rd month,and 6th month postoperation,and at the last follow-up,DH increased significantly compared to preoperative levels,while PI,PT,and Cobb angle decreased significantly compared to preoperative levels,with statistically significant differences(P<0.05).All patients achieved bony fusion at last follow-up,and no surgery-related complications occurred.Conclusion OLIF combined with lateral vertebral body screw fixation technology can achieve good clinical efficacy and imaging results in the treatment of singlesegment lumbar tuberculosis infection.