腰椎侧路椎体间融合术减少退变性脊柱侧凸固定节段的临床研究  

Effect of lateral lumbar interbody fusion to reduce the instrumented vertebrae for adult degenerative scoliosis

作　　者：吴文坚[1] 梁裕[1] 曹鹏[1] 张兴凯[1] 郑涛[1] 裘剑如[1] WU Wen-jian;LIANG Yu;CAO Peng;ZHANG Xing-kai;ZHENG Tao;QIU Jian-ru(Department of Orthopedics,Shanghai Ruijin Hospital,Shanghai Jiaotong University School of Medicine,Shanghai,200025,China)

机构地区：[1]上海交通大学医学院附属瑞金医院骨科,200025

出　　处：《中国骨与关节杂志》2021年第10期732-736,共5页Chinese Journal of Bone and Joint

摘　　要：目的评估腰椎侧路椎体间融合术是否会减少退变性脊柱侧凸患者固定融合节段。方法选取2014年1月至2018年9月,33例在我院行微创矫形术的退变性脊柱侧凸患者,其中女21例,男12例,年龄58~82岁,平均(72.8±4.5)岁。9例采用经腰大肌腰椎侧方椎间融合术(lateral lumbar interbody fusion,LLIF),24例采用斜外侧腰椎椎体间融合术(oblique lumbar interbody fusion,OLIF)。所有患者均采取分期微创手术的方式进行,第一期从侧方植入LLIF/OLIF融合器,第二期从后路植入经皮椎弓根螺钉或经Wiltse入路行腰椎椎弓根内固定术。所有患者在两次手术前后均使用EOS系统摄站立位脊柱全长X线片,应用EOS软件系统测量、评估患者的矢状面平衡参数包括骨盆入射角(pelvic incidence,PI),骨盆倾斜角(pelvic tilt,PT),腰椎前凸角(lumbar lordosis,LL),矢状面垂直轴(sagittal vertical axis,SVA)以及冠状面Cobb’s角。并在第一期手术前后由一组资深医师评估、计划固定融合范围。在术前、第二期术后3个月和末次随访时评估患者的Oswestry功能障碍指数(oswestry disability index,ODI)和疼痛视觉模拟评分(visual analogue scale,VAS)。结果本组随访时间24~66个月,平均35.1个月。第一期手术后,患者侧凸Cobb’s角较术前明显改善;LL、SVA、PT均较术前明显改善。患者末次随访时腰痛VAS评分、ODI也显著改善。LLIF/OLIF术后需固定节段数量较术前明显减少,有51.5%的患者(17/33)经评估可以缩短固定节段。结论腰椎侧路椎体间融合术可以改善退变性脊柱侧凸的冠状面和矢状面平衡,从而可能缩短固定融合的节段。Objective To explore whether lateral lumbar interbody fusion(LLIF/OLIF)will reduce the instrumented vertebrae in patients with degenerative scoliosis.Methods From January 2014 to September 2018,33 patients with degenerative scoliosis underwent staged minimally invasive surgery in our hospital,including21 females and 12 males with an mean age of(72.8±4.5)years(range:58-82 years).Nine patients were treated with lateral lumbar interbody fusion(LLIF),while 21 patients with oblique lumbar interbody fusion(OLIF).All patients were treated with lateral lumbar interbody fusion(LLIF/OLIF)first,and were followed by posterior percutaneous pedicle screw fixation or pedicle screw fixation via Wiltse approach.All patients took a full-length X-ray of the spine with EOS imaging system.The EOS software was used to measure and evaluate sagittal balance parameters including pelvic incidence(PI),pelvic tilt(PT),lumbar lordosis(LL),sagittal vertical axis(SVA)and coronal Cobb’s angle.The instrumented vertebrae was evaluated by a group of senior spine surgeons before and after the first surgery.ODI and VAS were evaluated before surgery,3 months after surgery and at the final follow-up.Results The mean follow-up was 35.1 months(range:24-66 months).After the first operation,the Cobb’s angle,LL,SVA and PT were significantly improved.At the last follow-up,VAS and ODI were also significantly improved.The intended instrumented vertebrae after LLIF/OLIF was significantly reduced compared with that preoperatively,and 51.5%of patients(17/33)were evaluated to reduce the instrumented vertebrae.Conclusions Lateral lumbar interbody fusion(LLIF/OLIF)can significantly improve the coronal and sagittal balance of the degenerative scoliosis,and may reduce the instrumented vertebrae.

关 键 词：腰椎 脊柱侧凸 脊柱融合术 

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