斜外侧腰椎椎间融合术联合后路导航经皮置钉固定治疗腰椎滑脱症的早期疗效  

Clinical and radiographic evaluation of oblique lumbar interbody fusion combined with percutaneous pedicle screw fixation on computer navigation for lumbar spondylolisthesis

作　　者：方忠[1] 高放[1] 李锋[1] 刘广武[1] 郭建峰[1] 李勇[1] 徐勇[1] 吴巍[1] 关邯峰[1] 廖晖[1] 曾恒[1] 熊伟[1] 

机构地区：[1]华中科技大学同济医学院附属同济医院骨科,武汉430030

出　　处：《中华骨科杂志》2017年第16期980-988,共9页Chinese Journal of Orthopaedics

基　　金：国家自然科学基金项目（81472133）,国家重点研发计划项目（2016YFB1101300）

摘　　要：目的观察斜外侧腰椎椎间融合术（oblique lumbar interbody fusion，OLIF）联合后路导航经皮置钉固定治疗腰椎滑脱症的早期临床疗效。方法2014年10月至2016年5月期间，接受OLIF联合后路导航经皮置钉固定手术治疗I、Ⅱ度腰椎滑脱症患者20例，男8例、女12例；年龄29~77岁，平均（54．1±12．3）岁。记录患者手术时间、术中出血量及并发症的情况；于术前、术后1周、术后3、6、12个月及末次随访时进行腰痛和下肢痛的疼痛视觉模拟评分（visual analogue scale，VAS）、Oswestry功能障碍指数（Oswestry disability index，ODI）、健康调查简表（the MOS item short from health survey，SF-36）评价以评估临床疗效；并同期行腰椎x线，术后6个月行腰椎CT±三维重建及MR检查，测量和评估椎间隙高度、椎间孔大小、硬膜囊面积和矢状径、间隙前凸角、腰椎前凸角、滑脱率、椎间融合率等改变情况。结果所有患者手术时间平均为（119．0±23．8）min，术中出血量平均为（57．8±20．6）ml。术后均获得随访，随访时间12-30个月，平均（22．9±4．8）个月。腰痛VAS评分、下肢痛VAS评分及ODl分别由术前（6．7±2．6）分、（6．3±2．7）分和50．5％±18．2％下降至末次随访时（1．3±1．0）分、（0．8±1．0）分和14．0％±9．6％，差异均有统计学意义；SF-36的PCS和MCS评分分别由术前（27．1±13．9）分和（51．O±22．7）分上升至末次随访时（67．3±18．9）分和（81．2±14．1）分，差异均有统计学意义。平均滑脱率由术前23．5％±7．4％下降至末次随访时4．2％±3．1％，差异有统计学意义；椎间隙高度、间隙前凸角及腰椎前凸角分别由术前（6．0±3．6）mm、1．8°±6．2°和39．2°±8．4°提高至末次随访时（10．8±1．7）mm、6．2°±3．5°和45．0°±7．8°，差异均有统计学意义。CT和MRI测量椎间孔大小分别由术前（140．Objective To assess the clinical effect of oblique lumbar interbody fusion （OLIF） combined with percutane- ous pediele screw fixation on computer navigation for lumbar spondylolisthesis. Methods Total 20 patients （8 males and 12 fe- males with average age of 54.1± 12.3 years ） with lumbar spondylolisthesis were enrolled in our study during Oct. 2014 and May. 2016. All patients were treated with OLIF combined with percutaneous pedicle screw fixation on computer navigation. Operation time, blood loss and complications were all recorded. Clinical and Radiographic evaluation were investigated on l week, 3 months, 6 months, 12 months postoperatively and final follow-up. Visual analogue scale （VAS） for low back pain and leg pain, Oswestry dis- ability index （ODI） for low back pain and the MOS item short form health survey （SF-36） were used to evaluate the clinical efficacy of surgery. Disc height, disc angle, lumbar lordosis and degree of upper vertebral slip of patients were investigated with X-ray. Cross-sectional area of intervertebral foramina was measured with three-dimensional CT and MRI. The cross-sectional area and sagittal diameter of the thecal sac were measured on T2-weighted axial and sagittal magnetic resonance images. Accuracy of pedicle screw placement was investigated with three-dimensional CT. Fusion rate was investigated with three-dimensional CT and X- ray. Results All patients were followed for 12-30 months （22.9±4.8 months）. The mean operation time was （119.0±23.8） rain, the mean blood loss was （57.8±20.6） ml. VAS for low back pain, VAS for leg pain, and ODI were significantly improved from （6.7± 2.6）, （6.3±2.7） and 50.5%±18.2% preoperatively to （1.3±1.0）, （0.8±1.0） and 14.0%±9.6% at the latest follow-up. The SF-36 PCS and MCS scores were improved from （27.1±13.9） and （51.0±22.7） preoperatively to （67.3±18.9） and （81.2±14.1） at the latest fol- low-up. Disc height, disc angle, lumbar lordosis were significantly increased f

关 键 词：腰椎 脊椎滑脱 脊柱融合术 外科手术 计算机辅助 

分 类 号：R687.3[医药卫生—骨科学]