腰椎斜外侧入路椎间融合术在退变性腰椎侧凸患者中的临床应用及早期疗效
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郑州大学第一附属医院

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河南省教育厅高等学校重点科研项目(编号:201303039)


Clinical application and early curative effect of oblique lumbar interbody fusion in patients with degenerative lumbar scoliosis
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The First Affiliated Hospital of Zhengzhou University

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The key research projects of Henan higher education institutions (201303039)

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    摘要:

    [目的] 探讨腰椎斜外侧入路椎间融合术在成人退变性腰椎侧凸患者中的临床应用及早期疗效。[方法] 回顾性分析我院2016年1月至2018年5月53例退变性腰椎侧凸患者的病例资料,其中28例行单独斜外侧入路方式治疗(OLIF组),25例行传统后路开放入路治疗(PLIF组)。记录患者的手术时间、术中出血量、切口长度、住院时间等情况,临床疗效评估采用腰痛视觉模拟评分(Visual Analog Scale,VAS)、功能障碍指数(Oswestry Disability Index,ODI),影像学参数评估采用腰椎侧凸Cobb角、矢状面垂直轴(Sagittal vertical axis,SVA)、冠状面垂直轴(Coronal vertical axis,CVA)、椎间隙高度、椎间孔高度及椎间孔面积等。[结果] 两组患者随访时间(15~40)月,平均(24.38±5.58)月。OLIF组的手术时间、术中出血量、切口长度、住院时间均小于PLIF组(P<0.05)。两组患者术后VAS评分、ODI指数术后均明显改善(P<0.05),术后第3天OLIF组的VAS评分、ODI指数明显低于PLIF组,差异具有统计学意义(P<0.05),但末次随访两组间差异无统计学意义(P>0.05)。两组腰椎侧凸Cobb角、SVA、CVA较术前明显改善(P<0.05),且两组间无统计学差异(P>0.05)。两组患者融合节段椎间隙高度、椎间孔高度、椎间孔面积较术前均增加(P<0.05),且OLIF组较PLIF组增加更显著差异具有统计学意义(P<0.05)。OLIF组总体并发症发生率(35.72%)低于PLIF组(52%),两组并发症发生率差异无统计学意义(x2=1.426,P=0.276),但PLIF组严重并发症的发生率明显高于OLIF组(Fisher确切概率法,P =0.012)。 [结论] 采用斜外侧腰椎椎间融合术治疗成人退变性腰椎侧凸是一种可供选择的微创治疗方式,具有切口小、恢复快、手术入路的相关并发症少等特点,早期疗效值得肯定,远期疗效需进一步随访。

    Abstract:

    [Objective] To evaluate the clinical application and early curative effect of oblique lumbar interbody fusion in patients with degenerative lumbar scoliosis.[Methods] This study retrospectively analyzed the case datas of 53 patients with degenerative lumbar scoliosis in our hospital from January 2016 to May 2018.Among which,28 cases underwent oblique lumbar Interbody fusion(OLIF group) and 25 cases underwent posterior lumbar interbody fusion(PLIF group).The operation time,intraoperative blood loss,incision length and hospital stay were recorded. The clinical effects were evaluated using Visual Analog Scale (VAS) and Oswestry Disability Index(ODI).The radiographic parameters were evaluated using the lumbar scoliosis cobb angle, sagittal balance (SVA), C7PL and CSCL distance (CVA,coronal plane balance),height of intervertebral space, upper-lower diameter of intervertebral foramen, intervertebral foramen area,etc.[Results] The average follow-up time was (24.38±5.58) months (15~40months).The operation time,intraoperative blood loss,incision length and hospital stay of the OLIF group were shorter than the PLIF group(P<0.05).The VAS scores for back pain,the ODI of the two groups were significantly decreased,which compared with the preoperative(P<0.05),which in OLIF group was significantly more decreased than in PLIF(P<0.05)at 3 days postoperatively,but at the last follow-up there were no significant difference between the two groups(P>0.05).The lumbar scoliosis Cobb angle, sagittal balance (SVA), C7PL and CSCL distance (CVA,coronal plane balance) were significantly improved after surgery for both groups, there were no significant difference between the two groups(P>0.05).The height of intervertebral space and intervertebral foramen, intervertebral foramen area of the two groups were significantly increased, which compared with the preoperative(P<0.05), but the OLIF group was more increased than the PLIF group(P<0.05).The overall complicationrate(52%)was slightly higher in the PLIF group than in the OLIF group(35.72%)without significant difference(x2=1.426,P=0.276).But the incidence of major complications in the PLIF group was significantly higher than that in the OLIF group(P=0.012). [Conclusion] Treatment of adult degenerative lumbar scoliosis with oblique lateral lumbar interbody fusion is an alternative minimally invasive treatment and it has the characteristics of small incision, quick recovery, and fewer complications related to the surgical approach. The early efficacy is worthy of recognition, but long-term efficacy requires further follow-up.

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  • 收稿日期:2019-10-11
  • 最后修改日期:2019-12-17
  • 录用日期:2019-12-23
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