侧前方椎体间融合术治疗退行性腰椎侧凸的早期临床疗效  

Short-term clinical analysis of lumbar lateral anterior interbody fusion in the treatment of degenerative lumbar scoliosis

作　　者：赵斌[1] 齐德泰 赵轶波[1] 陆向东[1] 赵晓峰[1] 周润田 王晓楠 Zhao Bin;Qi Detai;Zhao Yibo;Lu Xiangdong;Zhao Xiaofeng;Zhou Runtian;Wang Xiaonan(Department of Orthopaedics,the Second Hospital of Shanxi Medical University,Taiyuan 030001,China)

机构地区：[1]山西医科大学第二医院骨科,太原030001

出　　处：《中华骨科杂志》2021年第18期1333-1341,共9页Chinese Journal of Orthopaedics

基　　金：山西省科技攻关计划(201903D321151);。

摘　　要：目的探讨腰椎侧前方椎体间融合术(lumbar lateral anterior interbody fusion,LLIF)治疗退行性腰椎侧凸的可行性及其早期临床疗效。方法选取2018年1月至2020年1月接受侧前方椎间融合术联合后路经皮椎弓根钉-棒内固定治疗的40例退行性腰椎侧凸畸形患者。男17例,女23例;年龄(65.4±7.2)岁(范围51~84岁)。所有患者均存在明显的腰背部疼痛,其中22例(55.0%)患者存在下肢疼痛、麻木或间歇性跛行。16例(40.0%)患者侧凸主弯凸向右侧,24例(60.0%)患者侧凸主弯凸向左侧。记录手术时间及术中出血量。主要观察指标为疼痛视觉模拟评分(visual analogue scale,VAS)、Oswestry功能障碍指数(Oswestry disability index,ODI)及健康调查简表(the MOS item short from health survey,SF-36)、畸形矫正情况、植骨融合时间及并发症发生情况。结果16例侧凸主弯凸向右侧者均采用左侧入路;24例侧凸主弯凸向左侧,其中6例凹侧(右侧)冠状位CT示有骨赘存在并融合者采用右侧入路,余采取左侧入路。单节段融合8例(20.0%),双节段12例(30.0%),三节段16例(40.0%),四节段4例(10%)。22例存在下肢神经损害症状者中6例需要二期行单侧椎板开窗减压术。40例患者均顺利完成手术,手术时间(255±37)min(范围130~345 min),术中出血量(100±16.2)ml(范围10~505 ml)。所有患者均获得随访,随访时间(12.8±4.5)个月(范围6~24个月)。术前VAS评分为(5.7±1.0)分,术后第1天改善至(3.5±0.7)分,末次随访时为(1.4±0.3)分,差异有统计学意义(F=2322.229,P<0.001)。术前ODI为79.9%±9.3%,术后第1天为51.6%±8.9%,末次随访时为11.7%±2.2%,差异有统计学意义(F=3770.411,P<0.001)。术前SF-36为(68.6±5.3)分,术后第1天为(78.4±5.5)分,末次随访时提高至(109.9±4.9)分,差异有统计学意义(F=21736.486,P<0.001)。术前腰椎侧凸Cobb角为27.8°±14.1°,术后第1天矫正为7.5°±3.5°,末次随访时维持在8.5°±3.8°,差异有统计学意义(F=3.551,P<0.00Objective To investigate the feasibility and early clinical effect of lumbar lateral anterior interbody fusion in the treatment of degenerative lumbar scoliosis.Methods Forty patients with degenerative lumbar scoliosis who underwent lumbar lateral anterior interbody fusion combined with posterior percutaneous pedicle screw and rod internal fixation from January 2018 to January 2020 were selected.There were 17 males and 23 females;The age was 65.4±7.2 years(range 51-84 years).All patients had obvious low back pain,of which 22 patients(55.0%)had lower limb pain,numbness or intermittent claudication.16 patients(40.0%)had scoliosis and the main curve protruded to the right,and 24 patients(60.0%)had scoliosis and the main curve protruded to the left.The operation time and intraoperative bleeding were recorded.The main outcome measures were visual analogue scale(VAS),Oswestry disability index(ODI),the MOS item short from health survey(SF-36),deformity correction,bone graft fusion time and complications.Results The left approach was used in 16 cases of scoliosis with the main curve protruding to the right;In 24 cases,the main curve of scoliosis protruded to the left,of which 6 cases showed osteophyte on the concave side(right side)of coronal CT and the right approach was adopted,while the rest were adopted the left approach.Single segment fusion was performed in 8 cases(20.0%),double segment fusion in 12 cases(30.0%),three segment fusion in 16 cases(40.0%),and four segment fusion in 4 cases(10%).Among the 22 patients with symptoms of lower limb nerve damage,6 needed secondary unilateral laminectomy.All 40 patients completed the operation successfully,the operation time was 255±37 min(range 130-345 min)and the amount of intraoperative bleeding was 100±16.2 ml(range 10-505 ml).All patients were followed up for 12.8±4.5 months(range 6-24 months).The preoperative VAS score was 5.7±1.0,improved to 3.5±0.7 on the first day after operation,and 1.4±0.3 at the last follow-up.The difference was statistically significant(F=

关 键 词：腰椎 椎间盘退行性变 脊柱侧凸 脊柱融合术 

分 类 号：R687.3[医药卫生—骨科学]