Stand-alone XLIF治疗退变性脊柱侧凸  

Stand-alone XLIF for the treatment of degenerative scoliosis

作　　者：许俊杰 吴增晖 陈恩良 杨善智 梁达轩 XU Junjie;WU Zenghui;CHEN Enliang;YANG Shanzhi;LIANG Daxuan(Department of Orthopaedics,General Hospital of Southern Theatre Command,Guangzhou,Guangdong 510010,China)

机构地区：[1]南部战区总医院骨科,广州510010

出　　处：《中国骨科临床与基础研究杂志》2020年第4期204-208,共5页Chinese Orthopaedic Journal of Clinical and Basic Research

摘　　要：目的评估Stand-alone XLIF(即不使用螺钉内固定的单纯极外侧入路椎间融合术)治疗退变性脊柱侧凸(DS)的临床疗效。方法回顾性分析南部战区总医院采用Stand-alone XLIF治疗的15例DS患者的临床资料,其中单节段8例、双节段4例、三节段1例、四节段2例,共27个节段。采用腰椎Oswestry功能障碍指数(ODI)、日本骨科学会(JOA)评分和腰腿痛视觉模拟量表(VAS)评分评估患者的临床疗效;测量术前和末次随访时腰椎冠状面Cobb角和椎间孔高度,观察随访期间植骨融合及并发症发生情况。结果随访时间1~9年,平均随访时间4.2年。末次随访时腰椎ODI、JOA评分和VAS评分均较术前改善(P<0.05),术前、末次随访腰椎冠状面Cobb角和椎间孔高度分别为(28.1±5.8)°、(11.7±3.6)°和(16.3±2.5)、(19.2±2.7)mm,手术前后比较,差异有统计学意义(P<0.05)。术后1年24个节段(89%)获植骨融合,3个节段植骨延迟愈合。术后4例出现腹胀,5例出现腹股沟区一过性麻木或疼痛。随访期间未有内固定松动、感染并发症发生。结论在合理选择适应证的前提下,Stand-alone XLIF具有微创、术后恢复快的优势,可有效治疗DS。Objective To evaluate the clinical efficacy of the treatment of degenerative scoliosis(DS)by Stand-alone XLIF,namely,extreme lateral interbody fusion without screw internal fixation.Methods Clinical data of 15 DS patients treated with Stand-alone XLIF in General Hospital of Southern Theatre Command were retrospectively analyzed.A total of 27 levels were involved,including single level in 8 cases,two levels in 4,three levels in 1 and four levels in 2 cases.Clinical outcomes were assessed according to Oswestry disability index(ODI),visual analog scale(VAS)score,and Japanese Orthopaedic Association(JOA)score.Radiographic images were used to evaluate the coronal Cobb angles and the foraminal heights before the surgery and at the latest follow-up,bone graft fusion and complications were observed during the follow-up.Results All the patients were followed-up from 1 to 9 years,with the average time of 4.2 years.The average ODI,VAS score and JOA score at the final follow-up improved when compared with preoperative ones(P<0.05).The mean preoperative coronal Cobb angle and foraminal height were(28.1±5.8)°,(16.3±2.5)mm,which improved to an average of(11.7±3.6)°,(19.2±2.7)mm at the last follow-up respectively(P<0.05).Solid fusion was observed in 24 levels(89%)at 1 year after surgery,delayed union occurred in 3 levels.There were abdominal distension in 4 cases and temporary thigh numbness or pain in 5 cases after the surgery.No complications such as loosening of fixation,infection had happened.Conclusion Stand-alone XLIF may be an effective technique for the selected DS patients with the advantages of minimally invasive procedure and rapid postoperative recovery.

关 键 词：脊柱侧凸 退变性疾病 脊柱融合术 极外侧入路 Stand-alone 

分 类 号：R682.3[医药卫生—骨科学] R687.3[医药卫生—外科学]