斜外侧腰椎椎间融合联合影像学评估在腰椎退行性病变中的应用及其机制的初步探讨  

Application of oblique lateral interbody fusion combined with imaging evaluation in lumbar degenerative diseases and its mechanism

作　　者：邱宇[1] 魏立[1] 向前生[1] 李艳超[1] 魏祥科[1] QIU Yu;WEI Li;XIANG Qiansheng;LI Yanchao;WEI Xiangke(Department of Orthopedics, First People's Hospital of Yibin. Yibin 644000, Sichuan,China)

机构地区：[1]宜宾市第一人民医院骨一科,四川宜宾644000

出　　处：《中华骨与关节外科杂志》2019年第2期102-105,共4页Chinese Journal of Bone and Joint Surgery

摘　　要：背景:腰椎椎间融合术是治疗腰椎退行性病变的经典手术方式之一,斜外侧腰椎椎间融合(OLIF)因其采用解剖入路,手术并发症少,具有良好的可行性。目的:探讨OLIF联合影像学评估在腰椎退行性病变中的应用及其间接减压机制。方法:前瞻性纳入2013年6月至2015年6月行OLIF治疗的43例退行性腰椎管狭窄症患者,男31例,女12例;年龄38～74岁,平均(54.2±11.5)岁。记录患者术前及随访过程的临床疗效和影像学指标评分。结果:手术时间为34～70 min,平均(46.0±11.5)min;术中出血量为25～110 ml,平均(58.0±22.7)ml;术中未出现神经和血管损伤等并发症。术前、术后3个月和术后1年分别记录腰痛VAS、腿痛VAS、ODI、JOA和SF-36的数据。腰痛VAS、腿痛VAS、ODI在随访过程中均呈下降趋势(P均<0.05);JOA和SF-36在随访过程中均呈上升趋势(P均<0.05)。比较患者手术前后的影像学指标评分,椎间隙背侧高度、椎间孔高度、椎间孔面积、椎管内径及椎管面积均较术前明显增加(P<0.05)。术后并发症5例(11.6%),随访或二次手术后均缓解。结论:OLIF通过间接减压的方式达到缓解患者症状的目的,其手术可行性高,疗效好,并发症少、可控,为治疗退行性腰椎管狭窄症提供新的手术思路。Background:Lumbar interbody fusion is a classic method for the treatment of lumbar degenerative diseases.Oblique lateral interbody fusion(OLIF)has less surgical complications due to its anatomical approach and has good feasibility.Objective:To investigate the efficacy of OLIF combined with imaging assessment in lumbar degenerative diseases and the mechanism of indirect decompression.Methods:From June 2013 to June 2015,43 patients who underwent OLIF surgezy in our hospital for degenerative lumbar spinal stenosis were included in the study including 31 males and 12 females with the age ranging from 38 to 74 years and the average as(54.2±11.5)years old.The clinical efficacy indexes and imaging observation indexes before the operation and during the follow-up were recorded.Results:The operation time ranged from 34 to 70 min with the mean as(46.0±11.5)min.The intraoperative blood loss volume ranged from 25 to 110 ml with the mean as(58.0±22.7)ml.No complications such as nerve and vascular injury occurred during the operation.Data of various indicators like VAS of low back pain,VAS of leg pain,ODI,JOA,and SF-36 were recorded before surgery,3 months and 1 year after surgery follow-up.The VAS of low back pain,VAS of leg pain and ODI showed a downward trend during the follow-up(P<0.05).The JOA and SF-36 showed an upward trend during the follow-up(P<0.05).The imaging indexes containing the height of the dorsal intervertebral space,the height of the intervertebral foramen,the area of the intervertebral foramen,the in-ner diameter of the spinal canal and the area of the spinal canal significantly increased compared with those before operation(P<0.05).5 patients(11.6%)had postoperative complications that were alleviated during the follow-up or after secondary sur-gery.Conclusions:OLIF achieves the goal of relieving the symptoms of patients by indirect decompression.It has high surgi-cal feasibility,good curative effect,less complications and controllability.It provides a new surgical idea for the treatment of degenerative

关 键 词：斜外侧腰椎椎间融合 腰椎退行性病变 影像学 机制 

分 类 号：R687.3[医药卫生—骨科学]