斜外侧入路椎体间融合术19例临床疗效分析

Clinical analysis of 19 cases of oblique lateral interbody fusion

关键词:  斜外侧入路  椎体间融合  微创手术  临床疗效

Key words:  oblique lateral approach  interbody fusion  minimally invasive surgery  clinical efficacy

摘要:

目的　探讨斜外侧入路椎体间融合术(OLIF)的适应证及其安全性、可行性，并评价OLIF的临床疗效。方法　收集应用OLIF联合侧方置钉内固定治疗腰椎退行性疾病共19例患者的临床资料，所有病例均为单一节段，其中L3/4节段8例，L4/5节段11例。统计手术时间、术中出血量，手术前后及随访3个月的视觉模拟（VAS）评分和日本骨科协会评估治疗（JOA）分数，观察手术并发症，比较术前术后病变节段椎间隙及椎间孔高度变化情况。结果　19例患者均顺利完成手术，手术时间（133.47±32.13）min，术中出血量（69.47±48.22）mL。所有患者均获得随访，随访时间3个月，VAS评分由术前的(7.68±0.95）分下降到术后第1天的（2.16±0.77）分，术后3个月时为（1.47±0.84）分，与术前比较，差异有统计学意义(P＜0.05）。腰椎JOA评分由术前的（14.58±2.39）分上升到末次随访的（22.42±2.99）分(P＜0.05）。椎间隙高度由术前的（8.36±2.12）mm增加到术后的（15.08±0.90）mm，椎间孔高度由术前的（17.65±2.91）mm增加到术后的（21.52±2.30）mm，与术前比较，差异均有统计学意义(P＜0.05）。 术后并发症共3例：术后一过性左侧屈髋疼痛1例，左侧腹股沟区疼痛2例，至术后3个月患者上述症状均得到明显改善。无腹膜穿孔、结肠穿孔、输尿管损伤等入路相关的并发症，无大血管损伤、融合器移位、椎间隙感染等严重并发症。结论　OLIF不进入椎管、不显露神经、间接减压，手术出血少，可减少神经粘连、血肿等并发症，符合微创理念。近期临床效果满意，但融合率及远期疗效仍需长期、多中心、大样本临床观察。

Abstract:

Objective　To study the application, safety and feasibility of oblique lateral approach for oblique lateral interbody fusion (OLIF), and to evaluate the clinical efficacy of OLIF. 　Methods　A total of 19 patients with lumbar degenerative disease were treated with oblique lateral interbody fusion with lateral nail internal fixation. All cases were single segmental, there were 8 cases of L3/4 and 11 cases of L4/5. The operation time, intraoperative bleeding, VAS score and JOA score before and after operation and follow-up for 3 months were analyzed. The surgical complications, the changes of the intervertebral space and intervertebral foramen height of the diseased segments before and after the operation were observed. 　Results　All 19 patients had the surgery completed successfully, the main operation time was (133.47±32.13) min and the main intraoperative blood loss was (69.47±48.22) mL. All the patients were followed up for 3 months. The VAS score decreased from (7.68±0.95) to (2.16±0.77) on the first day after surgery and was (1.47±0.84) three months after operation, the difference was statistically significant compared with that before operation(P＜0.05). And the JOA score of lumbar increased from the preoperative (14.58±2.39) to the last follow-up of (22.42±2.99)(P＜0.05）, intervertebral height increased from (8.36±2.12) mm before surgery to (15.08±0.90) mm postoperatively, the intervertebral foramen height from the preoperative (17.65±2.91) mm to (21.52±2.30) mm postoperatively, the difference was statistically significant (P＜0.05). Postoperative complications were found in 3 cases: postoperative transient left hip pain in 1 case, left side groin pain in 2 cases, the above symptoms were significantly improved at the last follow-up of patients. There were no peritoneal perforation, colon perforation, ureteral injury and other surgery-related complications, and there were no major vascular injury, fusion shift, intervertebral space infection and other serious complications. 　Conclusion　OLIF does not enter the spinal canal, does not expose the nerve, has indirect decompression and less bleeding, and can reduce complications such as nerve adhesion and hematoma, which is in line with the concept of minimally invasive surgery. The short-term clinical effect is satisfactory, but the fusion rate and long-term effect still need long-term, multi center and large sample clinical observation.