微创小切口侧前方腰椎间融合术治疗腰椎退变性疾病的近期疗效和围手术期并发症  

Mini-open lateral-anterior lumbar interbody fusion for lumbar spinal degeneration diseases: short-term results and perioperative complications

作　　者：郑召民[1] 章健 刘辉[1] 王建儒 陈凡 龙军[1] 崔昊文 王华[1] 李泽民[1] ZHENG Zhaomin;ZHANG Jian;LIU Hui(Department of Spine Surgery, The 1st Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, 510080, China)

机构地区：[1]中山大学第一附属医院脊柱外科,广州市510080

出　　处：《中国脊柱脊髓杂志》2018年第5期410-417,共8页Chinese Journal of Spine and Spinal Cord

摘　　要：目的:评估微创小切口侧前方腰椎间融合术(mini-open lateral-anterior lumbar interbody fusion,La LIF)治疗腰椎退变性疾病的近期疗效和围手术期并发症。方法:分析2016年4月~2017年5月应用La LIF治疗的63例(94个节段)腰椎退变性疾病患者的资料,男23例,女40例,年龄42~86岁(61±15岁)。腰椎间盘突出症8例,腰椎管狭窄症40例,腰椎滑脱症7例,成人退变性侧凸症8例。融合节段为单节段38例,双节段20例,3节段4例,4节段1例。L1/2 3例,L2/3 7例,L3/4 31例,L4/5 53例。不附加内固定即独立的(stand alone)La LIF共56例;同时行二期后路内固定术7例,其中2例非计划内后路手术(1例腰椎管狭窄症因术中终板损伤而行后路内固定术,1例腰椎间盘突出症因术后cage下沉及症状缓解不满意而二期在外院行后路腰椎椎弓根内固定术),另5例退变性侧凸症行计划内后路减压或不减压椎弓根内固定术。记录手术时间、术中出血量、术后并发症,比较术前、术后1个月、术后3个月和末次随访时的腰痛VAS评分及Oswestry功能障碍指数(ODI),比较术前及末次随访时SF-36评分及X线片上手术节段椎间孔高度(intervertebral foramen height,FH)、椎间隙高度(intervertebral disc height,DH)和椎间孔面积(intervertebral foramen area,FA)。结果:63例患者完成随访,随访时间6.0±1.2个月(4~8个月)。单节段平均手术时间81±12min,平均术中出血量30±10ml;双节段平均手术时间130±21min,平均术中出血量50±12ml;3节段平均手术时间198±25min,平均术中出血量150±20ml;4节段手术时间220min,术中出血量300ml。术中出现静脉损伤1例,腹膜损伤1例,终板损伤2例(共3个节段)。术后1例出现切口红肿,对症治疗后缓解;4例出现一过性大腿前方疼痛或感觉异常,均在术后1个月内消失;1例出现下肢乏力,8周恢复正常。术后随访融合器下沉2例,融合器轻度移位8例。无病例因内置物失败、重要脏器损伤、术区�Objectives： To evaluate the short-term clinical outcomes and complications of mini-open lateral-anterior lumbar interbody fusion（LaLIF） for lumbar spinal degeneration disease. Methods： From April 2016 to May 2017, total of 63 patients（94 levels） with lumbar spinal degeneration disease underwent LaLIF surgery in our hospital were reviewed. There were 23 males and 40 females, with an average age of 61±15 years old （range, 42-86 years）. The diagnosis included lumbar spinal stenosis in 40 cases, lumbar spondylolisthesis in 7 cases, adult degenerative scoliosis in 8 cases, lumbar disc herniation in 8 cases. The fusion level included single level in 38 cases, double levels in 20 cases, three levels in 4 cases, four levels in 1 case, a total of 94 surgical fusion levels. The segmental distribution included L1/2 in 3 cases, L2/3 in 7 cases, L3/4 in 31 cases, L4/5 in 53 cases. 56 cases did not perform posterior internal fixation. 7 patients accepted second stage posterior fixation, including 2 unplanned posterior operation, among them 1 case of degenerative lumbar spinal stenosis plus posterior fixation due to intraoperative endplate injury and 1 case of lumbar intervertebral disc protrusion due to cage subsidence and dissatisfaction with symptomatic relief. 5 cases of degenerative lumbar scoliosis plus planned posterior internal fixation with or without decompression. The operation time, blood loss and postoperative complications were recorded. Visual analog scales（VAS） and Oswestry disability index（ODI） were assessed at preoperation and 1 month, 3 months and last follow-up after operation. SF-36 score, intervertebral disc height（DH）, intervertebral foramen height（FH） and foramen area（FA） on X-ray were measured at preoperation and final follow-up. Results： 63 patients completed follow-up. The average time of follow-up was 6.0±1.2 months. The mean operation time and blood loss were 81±12min and 30±10ml of 1 level, 130±21min and 50±12ml of 2 levels, 198±25min and 150±20ml of 3

关 键 词：侧前方腰椎间融合术 腰椎退变性疾病 微创小切口 临床疗效 并发症 

分 类 号：R687.3[医药卫生—骨科学] R681.5[医药卫生—外科学]