应用自稳定融合器的斜外侧入路腰椎间融合术治疗腰椎退行性病变疗效及安全性初探  

Oblique lumbar interbody fusion using anchored spacers in treatment of lumbar degenerative diseases: a primary clinical study

作　　者：张博彦 王作伟[1,2] 辛宗 戚茂杨 段婉茹[1,2] 陈赞[1,2] ZHANG Bo-yan;WANG Zuo-wei;XIN Zong;QI Mao-yang;DUAN Wan-ru;CHEN Zan(Department of Neurosurgery,Capital Medical University,Beijing 100053,China;Lab of Spinal Cord Injury and Functional Reconstruction,Spine Center,China International Neuroscience Institute(CHINA-INI),Xuanwu Hospital,Capital Medical University,Beijing 100053,China)

机构地区：[1]首都医科大学宣武医院神经外科,北京100053 [2]首都医科大学宣武医院脊髓损伤与功能重建实验室中国国际神经科学研究所脊柱中心,北京100053

出　　处：《中国现代神经疾病杂志》2022年第8期696-701,共6页Chinese Journal of Contemporary Neurology and Neurosurgery

基　　金：北京市自然科学基金-海淀原始创新联合基金资助项目(项目编号:L212039);北京市医院管理中心临床医学发展专项——“扬帆”计划(项目编号:XMLX202138);中国医学科学院中央级公益性科研院所基本科研业务费资助项目(项目编号:2021-JKCS-015);中国医学科学院中央级公益性科研院所基本科研业务费资助项目(项目编号:2021-JKCS-009)。

摘　　要：目的探讨应用自稳定融合器行斜外侧入路腰椎间融合术(OLIF)治疗腰椎退行性病变的疗效及安全性。方法纳入2020年4月至2022年1月首都医科大学宣武医院诊治的10例腰椎退行性病变患者,均于斜外侧入路腰椎间融合术中植入自稳定融合器,术后1周及6个月随访时进行视觉模拟评分(VAS)、日本骨科协会评分(JOA)和Oswestry功能障碍指数(ODI)评分,以评价疼痛症状和神经功能障碍改善程度,并通过腰椎X线、CT三维重建和MRI平扫观察神经减压效果和手术并发症。结果所有患者均顺利完成手术,手术时间平均为(128.90±35.16)min,术中出血量平均为(30.00±14.14)ml。与术前相比,术后1周和6个月时VAS(F=332.566,P=0.000)、JOA(F=244.125,P=0.000)和ODI(F=36.918,P=0.000)评分差异具有统计学意义;术后6个月时,VAS和ODI评分低于术后1周(均P=0.000)和术前(均P=0.000),JOA评分高于术后1周(P=0.000)和术前(P=0.000)。与术前相比,术后1周手术节段椎间隙高度(t=9.406,P=0.000)和硬膜囊面积(t=8.853,P=0.000)增加;术后6个月随访时,所有患者均可见手术节段骨性融合,无一例发生融合器移位、关节面塌陷或相邻椎体节段椎间盘退行性变等并发症。结论斜外侧入路腰椎间融合术治疗腰椎退行性病变可取得满意疗效;应用自稳定融合器可免去植入后入路内固定系统,对手术节段的稳定性无影响,安全性较高。Objective To evaluate the clinical effect of oblique lumbar interbody fusion(OLIF)surgery using anchored spacers in patients with lumbar degenerative diseases.Methods Total 10 patients with lumbar degenerative diseases treated at Xuanwu Hospital,Capital Medical University from April 2020 to January 2022 were enrolled in this retrospective study.All cases underwent OLIF surgery with anchored spacer.Visual Analog Scales(VAS),Japan Orthopedic Association Scores(JOA) and Oswestry Disability Index(ODI) were used to evaluate the pain symptoms and degree of neurology dysfunction improvement,while X-ray scan,3 D-CT scan and MRI were used to evaluate radiology outcomes and surgical complications during one week and 6 months after the surgery.Results All 10 patients completed the surgery successfully,the mean surgical time was(128.90±35.16) min,and the mean blood loss was(30.00 ±14.14) ml.VAS(F=332.566,P=0.000),JOA(F=244.125,P=0.000) and ODI(F=36.918,P=0.000)scores during one week and 6 months after the surgery showed significant improvement,compared with preoperative scores.VAS and ODI scores decreased at 6 months after the surgery than that before surgery(P=0.000,for all) and one week after surgery(P=0.000,for all).JOA score increased at 6 months after the surgery than that before surgery(P=0.000) and one week after surgery(P=0.000).The postoperative height of intervertebral space(t=9.406,P=0.000) and area of dural sac(t=8.853,P=0.000) were also significantly improved.At 6 months after the surgery,all patients had bony fusion at the surgical segment,and no complications such as fusion cage displacement,articular surface collapse or disc degeneration at the adjacent segment occurred.Conclusions OLIF surgery leads to satisfactory clinical outcomes in the treatment of lumbar degenerative diseases.The use of anchored spacers can reduce the need for posterior internal fixation,it has no effect on the stability of the surgical segment and has high safety.

关 键 词：脊柱疾病 腰椎 脊柱融合术 神经外科手术 

分 类 号：R687.3[医药卫生—骨科学]