可扩张通道下OLIF入路联合后路内固定治疗腰椎退行性疾病的疗效分析  

Treatment of lumbar spinal degenerative diseases with OLIF approach combined with posterior internal fixation under expandable channels

作　　者：张圣飞[1] 张亮[1] 张志强[1] 蔡俊[1] 黄吉军[1] 冯新民[1] ZHANG Sheng-fei;ZHANG Liang;ZHANG Zhi-qiang(Department of Orthopedics,Subei People's Hospital of Jiangsu Province,Yangzhou 225001,China)

机构地区：[1]苏北人民医院骨科,江苏扬州225001

出　　处：《吉林医学》2021年第2期325-329,共5页Jilin Medical Journal

摘　　要：目的:探讨可扩张通道辅助下斜外侧入路腰椎间隔合术(OLIF)入路联合后路肌间隙入路内固定治疗腰椎退行性疾病的疗效。方法:回顾性分析行可扩张通道辅助下OLIF入路联合后路肌间隙入路内固定治疗的腰椎退行性疾病患者20例,选择同期行传统经椎间孔椎体间隔合(TLIF)手术患者20例进行对照,两组患者都是L 4~5单节段病变。比较两组患者术中出血量、术后引流量、手术时间、术后下床时间、术后住院天数及并发症情况;比较术前、术后3 d以及末次随访时两组患者的椎间孔高度、椎间隙高度以及ODI指数、JOA评分、VAS评分。结果:两组患者均顺利完成手术,所有患者术后腰痛及下肢疼痛麻木等症状明显改善。OLIF组患者术中出血量、术后下床时间以及术后住院天数均显著少于TLIF组(P<0.05);OLIF组术后均未放置切口引流管,TLIF组术后均放置切口引流管;两组患者手术时间比较,差异无统计学意义(P>0.05)。两组患者术后ODI指数、JOA评分、VAS评分以及椎间隙高度、椎间孔高度较术前均显著改善(P<0.05),但两组间比较差异无统计学意义(P>0.05)。OLIF组患者未出现脑脊液漏,术后切口均顺利愈合。TLIF组患者术后发生脑脊液漏1例,切口愈合不良3例。结论:可扩张通道辅助下OLIF入路联合腰椎后路肌间隙入路内固定治疗腰椎退行性疾病临床疗效显著,同时还具有微创、安全、有效、快速康复等优势。Objective To investigate the efficacy of OLIF approach combined with posterior internal fixation in the treatment of lumbar degenerative diseases with the help of expandable channels.Method A retrospective analysis of 20 patients with lumbar degenerative diseases treated with expandable channel assisted by OLIF approach combined with posterior muscle space approach internal fixation in our hospital.20 patients who underwent TLIF approach during the same period were selected for comparison.Patients in both groups were L 4~5 single-segment lesions with clear indications for surgery and exclusion of surgical contraindications.Comparison of intraoperative blood loss,postoperative drainage,surgical time,bed time,postoperative hospital stay,and complications between the two groups;comparison of intervertebral foramen height,Intervertebral space height,ODI index,JOA score,VAS score.Results Both groups of patients successfully completed the operation,and all patients had significantly improved symptoms such as low back pain and numbness in the lower extremities.The intraoperative blood loss,postoperative bed time,and postoperative hospital stay were significantly less in the OLIF group than in the TLIF group(P<0.05);no incision drainage tube was placed in the OLIF group,and incision drainage tubes were placed in the TLIF group;The postoperative ODI index,JOA score,VAS score,and intervertebral space height and intervertebral foramen height were significantly improved in both groups compared with those before surgery(P<0.05),but there was no significant difference between the two groups(P>0.05).There was no cerebrospinal fluid leakage in the OLIF group,and the incisions healed smoothly.One patient in the TLIF group had cerebrospinal fluid leakage and three had poor incision healing.Conclusion The expansion-assisted OLIF approach combined with posterior lumbar spinal muscle space approach for internal lumbar spine degenerative diseases has significant clinical effects,and it also has the advantages of minimally invasive,saf

关 键 词：腰椎退行性疾病 斜外侧入路腰椎间融合术 OLIF TLIF 可扩张通道 

分 类 号：R687.3[医药卫生—骨科学]