采用微创腰椎椎间融合联合椎弓根钉棒固定治疗腰椎滑脱症的临床疗效  

Application value of oblique lateral interbody fusion combined with Wiltse approach in lumbar spondylolisthesis

作　　者：牛海明[1] 王庆春[1] 徐新宇 Niu Haiming;Wang Qingchun;Xu Xinyu(Department of Orthopedics, the People's Hospital of Guanyun County, Jiangsu 222200, China)

机构地区：[1]江苏省连云港市灌云县人民医院骨科,222200

出　　处：《骨科临床与研究杂志》2022年第2期98-103,110,共7页Journal Of Clinical Orthopedics And Research

摘　　要：目的探讨腰椎侧方入路融合术(OLIF)联合椎弓根钉棒固定(Wiltse入路)置入治疗腰椎滑脱症(LS)的临床疗效。方法2017年1月至2020年7月江苏省连云港市灌云县人民医院骨科收治的腰椎滑脱症患者27例,在正常L3~S1节段CT扫描的基础上采用OLIF联合Wiltse入路的方法,设为观察组;同时以单纯小切口Wiltse入路椎弓根螺钉固定术治疗的27例患者作为对照组。比较两组手术时间、暴露时间、显露出血量及总出血量、日本骨科协会评估治疗评分(JOA)、腰疼痛视觉模拟评分(VAS)改善率。设定责任节段,建造OLIF Stand alone(M1)模型、OLIF+左侧椎弓根钉棒固定模型(M2)和OLIF+双侧椎弓根钉棒固定模型(M3)。比较3种模型脊椎前屈、后伸、侧屈及旋转等生理活动下不同节段的相对活动度、逐渐融合期和椎弓根钉棒应力分布差异。结果相较于OLIF Stand alone(M1)模型而言,采用OLIF+左侧椎弓根钉棒固定模型(M2)和OLIF+双侧椎弓根钉棒固定模型(M3)对腰椎滑脱症的临床治疗效果更好。OLIF联合小切口Wiltse入路术的手术时间、暴露时间、显露出血量及总出血量指标均低于常规治疗组(P<0.05),联合组的JOA改善率,腰痛VAS评分分均优于常规治疗组(P<0.05)。结论OLIF联合Wiltse入路在腰椎滑脱症的临床治疗中临床效果更好,可给腰椎间融合固定节段提供足够的椎间稳定性。Objective To explore the clinical application value of oblique lateral interbody fusion(OLIF)combined with pedicle screw fixation(Wiltse approach)in the treatment of lumbar spondylolisthesis.Methods On the basis of normal L3-S1 segmental CT scanning,27 patients with lumbar spondylolisthesis treated by OLIF combined with Wiltse approach in the department of spinal orthopedics,the People's Hospital of Guanyun County,were selected as the observation group from January 2017 to July 2020.In the control group,27 patients were treated by traditional anterior focus debridement combined with posterior internal fixation,Exposure,exposure and total bleeding,JOA improvement rate,and lower back pain VAS score of the two groups of surgery were compared.In addition,responsibility segments were set to build OLIF Stand alone(M1)model,OLIF+left arch bar fixation model(M2)and OLIF+(M3).The relative activity,gradual fusion period and stress distribution of different segments of the anterior flexion,posterior extension,lateral flexion and rotation of the three models were compared.Result Compared with OLIF stand alone(M1)model,OLIF+left pedicle screw fixation model(M2)and OLIF+bilateral pedicle screw fixation model(M3)were more effective in the treatment of lumbar spondylolisthesis.The intraoperative indexes(operation time,exposure time,exposed blood volume and total blood loss)in the combined group(OLIF combined with small incision Wiltse approach)were lower than those in the routine treatment group(P<0.05).The improvement rate of JOA and the VAS score of low back pain in the combined group were better than those in the routine treatment group(P<0.05).Conclusion OLIF combined with Wiltse approach is more effective in the clinical treatment of lumbar spondylolisthesis and can provide sufficient intervertebral stability for lumbar interbody fusion.

关 键 词：脊柱融合术 腰椎 移位 Wiltse入路 

分 类 号：R68[医药卫生—骨科学]