斜外侧腰椎椎间融合术治疗单节段腰椎退变性疾病的近期疗效  

Short-term clinical outcome of single level degenerative lumbar diseases treated by minimally invasive surgery oblique lumbar interbody fusion

作　　者：沈俊宏 王建 刘超 李长青 张超 潘勇 周跃 

机构地区：[1]陆军军医大学新桥医院骨科,重庆400037

出　　处：《中华骨科杂志》2017年第16期997-1005,共9页Chinese Journal of Orthopaedics

摘　　要：目的探讨斜外侧腰椎椎间融合术（oblique lumbar interbody fusion，OLIF）治疗单节段腰椎退变性疾病的近期临床疗效。方法由通讯作者于2014年11月至2016年3月间完成49例单节段腰椎退变性疾病的OLIF手术，对临床和放射学资料进行分析。腰椎滑脱25例（51％）、椎间盘源性腰痛14例（28．6％）、腰椎不稳10例（20．4％）。所有病例分为初期组（24例）和后期组（25例），均接受单节段OLIF手术和经皮椎弓根钉一棒系统内固定。比较两组患者的手术时间、术中出血量、放射线暴露时间、围手术期并发症、临床和影像学结果，其中术中参数仅包括OLIF技术相关内容。采用疼痛视觉模拟评分（visual analogue scale，VAS）和Oswestry功能障碍指数（Oswestry disability index，ODI）评价近期临床疗效，采用对数曲线拟合回归分析评价OLIF技术的学习曲线。结果初期组手术时间（47．1±10．6min）明显长于后期组（37．2±10．0min），初期组术中放射线暴露时间（25．3±6．1）s明显长于后期组（17．1±6．9）S。手术时间和放射线暴露时间随完成病例数增加逐步减少，于大约20例后达到渐近线平台。初期组术中出血量（28．1±18．2）ml与后期组（24．4±10．9）ml的差异无统计学意义。初期组主要并发症包括供骨区疼痛11例（45．8％）、大腿麻木和（或）疼痛5例（20．8％）、髂腰肌和（或）股四头肌乏力2例（8．3％）、麻痹性肠梗阻1例（4．2％）和交感神经损伤1例（4．2％）。后期组主要并发症包括供骨区疼痛4例（16．0％）、大腿麻木和（或）疼痛3例（12．0％）、髂腰肌和（或）股四头肌乏力1例（4．0％）和交感神经损伤1例（4．O％）。所有并发症均在3月内消失。除供骨区疼痛外，两组其他并发症发生率分别为37．5％（初期组）和20．0％（后期组），但差异无统计学意义。49例患者�Objective To investigate the short-term clinical outcome of one-level degenerative diseases for a single sur- geon during his initial phase of performing a minimally invasive surgery oblique lumbar interbody fusion （OLIF） on the basis of perioperative parameters and follow-up data. Methods A prospective analysis of 49 consecutive patients that underwent a OLIF between November 2014 and March 2016 by corresponding author was performed. Only those patients that were single level, index surgeries were included. Every patient had a diagnosis of degenerative lumbar diseases including lumbar spondylolisthesis （25 cas- es）, discogenic low back pain （14 cases） or segmental instability （10 cases）. Patients underwent an indirect decompression and fu- sion using an expandable tubular retractor and single intervertebral cage with bilateral percutaneous pedicle screw fixation. 49 pa- tients were divided into the A group （the first 24 patients） and the B group （25 patients after the initial 24 patients）. The following data were compared between the two groups： surgical time for Skin-Skin （minutes）, estimated blood loss （ml）, radiograph exposure time （seconds）, the clinical and radiographic results, and intra-/postoperative complications. All intraoperative parameters only in- cluded the measurement and findings related with the OLIF procedure. The short-term clinical outcome of single level degenera- tive lumbar diseases treated by OLIF was assessed on the basis of follow-up data. The learning curve was measured using a loga- rithmic curve-fit regression analysis. Results Average operative time was significantly longer in the A group 47.1±10.6 min compared with the B group 37.2± 10.0 min. In comparison with the B group, the A group had significantly more X-ray exposure time （25.3±6.1 s versus 17.1±6.9 s）. The operative and X-ray exposure time gradually decreased as the series progressed, and an asymp- tote was reached after about 20 cases. There was no statistically significant dif

关 键 词：腰椎 椎间盘退行性变 脊柱滑脱 脊柱融合术 学习曲线 

分 类 号：R687.3[医药卫生—骨科学]