| 杨立进,陈博来,杨一帆,赵帅,李永津.微创斜外侧腰椎椎间融合术治疗腰椎融合术后邻近节段退行性变[J].脊柱外科杂志,2019,17(1):18-24. |
微创斜外侧腰椎椎间融合术治疗腰椎融合术后邻近节段退行性变  点此下载全文 (Fulltext) |
| 杨立进1 陈博来2* 杨一帆2 赵帅2 李永津2 |
1. 广州中医药大学研究生学院, 广州 510405;
2. 广东省中医院(广州中医药大学第二附属医院)
脊柱骨科, 广州 510120 |
| 基金项目： |
| DOI：10.3969/j.issn.1672-2957.2019.01.004 |
| 摘要点击次数: 1133 |
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| 摘要： |
| 目的 探讨斜外侧腰椎椎间融合术（OLIF）在治疗腰椎融合术后邻近节段退行性变（ASD）的临床疗效。方法 2015年8月-2017年5月，行腰椎后路减压植骨融合椎弓根内固定术42~102（74.6±19.7）个月后，发生ASD需再次手术的患者11例。发生ASD的节段均位于原融合节段上方，应用OLIF联合/不联合椎弓根钉行内固定治疗。记录手术时间、术中出血量、并发症、住院天数等。临床疗效评价采用疼痛视觉模拟量表（VAS）评分及Oswestry功能障碍指数（ODI）。摄腰椎标准正侧位、过伸过屈位X线片及CT，测量手术前后椎间孔高度（IFH）、椎间隙背侧高度（DH）、椎间隙腹侧高度（VH）等影像学参数。结果 所有患者顺利完成手术，术后随访（17.7±6.8）个月，手术时间（87±35）min，单节段手术时间（64±8）min（不含内固定操作），术中出血量（74.2±28.8）mL，住院（6.7±1.9）d。所有患者术后腰腿痛VAS评分及ODI均明显降低，影像学测量结果显示手术节段椎间隙VH、DH较术前分别增加（4.5±2.1）mm和（3.2±1.9）mm，IFH较术前增加（5.7±1.6）mm。2例（18.2%）患者在椎间隙处理过程中发生终板损伤，Cage下沉，术中联合椎弓根钉内固定，术后无相关临床症状；1例发生腹膜撕裂，术中请胃肠外科专家手术修复；1例出现交感神经链损伤致下肢症状，1例出现一过性术侧腰大肌无力，屈髋肌力3+级，经对症处理后恢复正常。结论 OLIF作为一种新的脊柱微创技术，为腰椎融合术后ASD提供了一项安全、有效的治疗方式，并获得良好的近期随访临床效果。 |
| 关键词：腰椎 脊柱融合术 椎间盘退行性变 手术后并发症 再手术 |
| Minimally invasive oblique lateral lumbar interbody fusion for adjacent segment degeneration after lumbar fusion Fulltext |
| YANG Li-jin1 CHEN Bo-lai2* YANG Yi-fan2 ZHAO Shuai2 LI Yong-jin2 |
1. Graduate School, Guangzhou University of Chinese Medicine, Guangzhou 510405, Guangdong, China;
2. Department of Spinal Orthopaedics, Guangdong Provincial Hospital of Chinese Medicine(Second Affiliated Hospital of Guangzhou University of Chinese Medicine)
, Guangzhou 510120, Guangdong, China |
| Fund Project: |
| Abstract: |
| Objective To investigate the clinical effect of oblique lateral lumbar interbody fusion (OLIF) in the treatment of adjacent segment degeneration(ASD) after lumbar fusion. Methods From August 2015 to May 2017, 11 patients with ASD after 42-102 (74.6±19.7) months of posterior lumbar decompression and interbody fusion with pedicle fixation operation who needed reoperation. All the segments with ASD were located above the original fusion segment and were treated with OLIF combined with/without pedicle screw fixation. The operation time, intraoperative blood loss, complications and length of stay were recorded. Clinical outcomes were evaluated with visual analogue scale (VAS) score and Oswestry disability index (ODI). The standard anteroposterior and lateral, hyperextension and hyperflexion roentgenographs and CT of the lumbar spines were taken to measure the image parameters of intervertebral foramen height (IFH), dorsal height (DH) and ventral height (VH) of intervertebral space before and after operation. Results All patients completed the operation successfully. The followup period was (17.7±6.8) months. The operation time was (87±35) min, the single segment operation time (excluding internal fixation operation) was (64±8) min. The intraoperative bleeding loss was (74.2±28.8) mL, and the hospital stay was (6.7±1.9) d. The low back and leg pain VAS score and ODI of were significantly decreased in all patients. Imaging measurements showed that VH and DH of operative intervertebral space increased by (4.5±2.1) mm and (3.2±1.9) mm respectively, and IFH increased by (5.7±1.6) mm. Endplate injury occurred in 2 (18.2%) patients during the treatment of intervertebral space, and the position of the fusion cage subsided. Pedicle screw fixation was used in the operation, and no postoperative clinical symptoms were observed. Peritoneal tear occurred and was repaired by expert gaistrointestinal surgeon during the operation in 1 patient. Lower extremity symptoms caused by sympathetic chain injury appeared, and transient psoas muscle weakness with hip muscle strength 3+ grade were found in 1 patient each, both returned to normal after symptomatic treatment. Conclusion As a new minimally invasive technique, OLIF provides a safe and effective treatment for ASD after lumbar fusion, and achieves good short-term follow-up clinical results. |
| Keywords:Lumbar vertebrae Spinal fusion Intervertebral disc degeneration Postoperative complications Reoperations |
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