极外侧入路腰椎椎间融合术治疗单节段腰椎管狭窄症的疗效及安全性  

Efficacy and safety of extreme lateral interbody fusion in the treatment of single segment lumbar spinal stenosis

作　　者：卢宏伟 杨正伟 许建中 何清义 LU Hong-wei;YANG Zheng-wei;XU Jian-zhong;HE Qing-yi(Department of Orthopedics,First Affiliated Hospital of Army Medical University,Chongqing 400038,China)

机构地区：[1]陆军军医大学第一附属医院骨科,重庆400038

出　　处：《局解手术学杂志》2020年第10期818-822,共5页Journal of Regional Anatomy and Operative Surgery

基　　金：陆军军医大学第一附属医院临床创新基金(SWH2016 JCZD-05)。

摘　　要：目的观察极外侧入路腰椎椎间融合术(XLIF)治疗单节段腰椎管狭窄症的临床疗效及安全性。方法纳入2012年1月至2017年12月在我院骨科行XLIF治疗的单节段腰椎管狭窄症患者43例。记录患者手术时间、术中出血量、住院时间、VAS评分、ODI、围手术期并发症发生情况,采用X射线片和CT三维重建测量手术前后腰椎间隙高度和椎管面积,并计算术后融合率,采用改良Macnab疗效评定标准评价手术效果。结果术后随访12~36个月,平均(23.7±6.7)个月;手术时间(64.1±15.2)min,术中出血量(61.6±30.6)mL,住院时间(4.7±1.8)d;末次随访VAS评分和ODI均显著低于术前,差异具有极显著性统计学意义(P<0.01);术后椎间隙高度、椎管面积均显著大于术前,差异具有极显著性统计学意义(P<0.01);所有患者均未发生脑脊液漏、血肿、感染等并发症,术后切口均一期愈合;3例患者术后出现屈髋无力,6周内恢复正常。术后6个月融合率为93%,术后12个月融合率为100%。Macnab疗效评定结果显示优良率为100%。结论XLIF具有手术时间短、术中出血少、术后恢复快、住院时间短等优点,用于治疗单节段腰椎管狭窄可获得较高的术后椎间融合率,手术安全性较高。Objective To observe the clinical efficacy and safety of extreme lateral interbody fusion(XLIF)in the treatment of single segment lumbar spinal stenosis.Methods A total of 43 patients with single segment lumbar spinal stenosis who underwent XLIF treatment in the orthopedics department of our hospital from January 2012 to December 2017 were included.The operation time,intraoperative blood loss,hospitalization time,VAS score,ODI and perioperative complications were recorded.The lumbar intervertebral space height and spinal canal area before and after surgery were measured by X-ray and CT three-dimensional reconstruction,and the postoperative fusion rate was calculated.The surgical effect was evaluated by the modified Macnab efficacy evaluation standard.Results The postoperative follow-up period was 12 to 36 months,with an average of(23.7±6.7)months.The operation time was(64.1±15.2)minutes,the intraoperative blood loss was(61.6±30.6)mL,and the hospitalization time was(4.7±1.8)days.The VAS score and ODI at the last follow-up were significantly lower than those before surgery,and the differences were extremely significant(P<0.01).Postoperative intervertebral space height and spinal canal area were significantly greater than those before surgery,and the differences were extremely significant(P<0.01).There was no complication such as cerebrospinal fluid leakage,hematoma and infection occurred,and all the surgical incisions healed at the first stage after operation.There were 3 patients developed hip flexion weakness after surgery,and returned to normal within 6 weeks.The fusion rate was 93%at 6 months after surgery,and it was 100%at 12 months after surgery.The results of Macnab efficacy evaluation showed that the excellent and good rate was 100%.Conclusion XLIF has the advantages of shorter operation time,less intraoperative bleeding,more rapid postoperative recovery,and shorter hospitalization time.It can obtain higher postoperative intervertebral fusion rate for single segment lumbar spinal stenosis,and the operat

关 键 词：微创手术 极外侧入路 腰椎椎间融合 腰椎管狭窄症 单节段 CT三维重建 

分 类 号：R681.5[医药卫生—骨科学]