斜外侧椎间融合联合侧方钢板固定治疗腰椎融合术后邻近节段疾病  

Application of oblique lateral fusion combined with lateral plate fixation in the treatment of adjacent segment diseases of lumbar spine

作　　者：赵永辉 陆声 钟晖 邹天南[1] 刘杰 陈家瑜 彭志 Zhao Yonghui;Lu Sheng;Zhong Hui;Zou Tiannan;Liu Jie;Chen Jiayu;Peng Zhi(Department of Orthopaedics,the First People's Hospital of Yunnan Province,Kunming 650032,China)

机构地区：[1]云南省第一人民医院骨科,昆明650032

出　　处：《中华骨科杂志》2022年第19期1262-1272,共11页Chinese Journal of Orthopaedics

基　　金：云南省基础研究专项-重点项目(201901S070102);云南省科技计划重大专项(202102AA310042);云南省"万人计划"名医专项(YNWR-MY-2019-058);云南省医学领军人才项目(L-2019006);云南省吕维加专家工作站(202005AF150038);云南省数字骨科重点实验室(202005AG070004);云南省数字骨科创新团队(202105AE160015)。

摘　　要：目的比较斜外侧椎间融合(oblique lumbar interbody fusion,OLIF)联合侧方钢板(lateral plate,LP)固定与后路腰椎椎间融合术(posterior lumbar interbody fusion,PLIF)治疗腰椎邻近节段疾病(adjacent segment disease,ASDis)的临床疗效。方法回顾性分析2016年8月至2019年10月采用OLIF-LP治疗21例ASDis患者的病历资料,男9例、女12例;年龄(59.3±7.0)岁(范围46~71岁)。手术节段:L2,31例、L3,416例、L4,54例。选取同期收治的年龄、性别及手术节段相匹配的采用PLIF治疗21例ASDis患者作为对照组。比较两组患者的手术时间、术中出血量、术后住院时间、视觉模拟疼痛评分(visual analogue scale,VAS)和Oswestry功能障碍指数(Oswestry disability index,ODI)、椎间隙高度(disc height,DH)和椎间孔高度(intervertebral foramen height,IFH)及腰椎前凸角(lumbar lordosis,LL)。组内比较采用方差分析,进一步两两比较采用Bonferroni检验;组间比较采用t检验。结果42例患者均获得随访,随访时间(23.7±7.4)个月(范围12~36个月)。OLIF-LP组手术时间为(97.6±18.0)min、术中出血量为(138.5±62.7)ml,较PLIF组[手术时间(154.6±42.4)min、术中出血量(288.6±55.3)ml]明显减少(P<0.05);OLIF-LP组术后住院时间为(4.4±1.3)d,PLIF组为(5.1±1.2)d,差异无统计学意义(P>0.05)。OLIF-LP组术后1、3个月VAS评分分别为(1.6±0.9)分和(1.4±0.8)分,PLIF组为(2.5±1.3)分和(2.0±1.0)分;OLIF-LP组术后1个月ODI为29.4%±4.7%,PLIF组为33.9%±7.6%,两组的差异有统计学意义(P<0.05);而术后12个月时两组VAS评分、ODI的差异均无统计学意义(P>0.05)。两组术后即刻、术后3个月及术后12个月DH、IFH、LL均较术前改善(P<0.05),术后即刻、术后3个月及术后12个月OLIF-LP组DH、IFH均优于PLIF组(P<0.05),而两组LL的差异则无统计学意义(P>0.05)。OLIF-LP组术中无血管、神经及腹腔脏器损伤,术后2例出现一过性下肢疼痛。PLIF组术中2例硬脊膜破裂予以修补,术后未出现脑脊�Objective To investigate the clinical efficacy of oblique lateral interbody fusion(OLIF)combined with lateral plate(LP)fixation and posterior lumbar interbody fusion(PLIF)combined with pedicle screw fixation in the treatment of adjacent segment disease(ASDis).Methods Data of 21 ASDis patients treated with OLIF-LP from August 2016 to October 2019 were selected,including 9 males and 12 females;age was 59.3±7.0 years(range,46-71 years).Target segments:L2,31 cases(4.8%),L3,416 cases(76.2%),L4,54 cases(19.1%).Twenty-one ASDis patients matched with age,sex and surgical segment and treated with PLIF were selected as the control group.The operation time,intraoperative bleeding,postoperative hospital stay,visual analogua scale(VAS),Oswestry disability index(ODI),disc height(DH),intervertebral foramen height(IFH)and lumbar lordosis(LL)were compared between the groups were tested by t-test.VAS score,ODI,DH,IFH and LL were compared within the group by ANOVA,and Bonferroni's test was used for pairwise comparison.Results All of 42 patients were followed up for 23.7±7.4 months(range,12-36 months).The operation time(97.6±18.0 min)and interpretative bleeding(38.5±62.7 ml)in OLIF-LP group were significantly lower than those in PLIF group(operation time 154.6±42.4 min)and interpretative bleeding(288.6±55.3 ml).There were significant differences between two groups(t=5.66,P<0.001;t=8.23,P<0.001);the postoperative hospital stay 4.4±1.3 d in OLIF-LP group was longer than that in PLIF group 5.1±1.2 d,but there was no significant difference(t=1.93,P=0.061);VAS score in OLIF-LP group at 1 month and 3 months after operation(1.6±0.9 points,1.4±0.8 points),and the ODI index(29.4%±4.7%)after one month operation was improved better than that of PLIF group(t=2.48,P=0.017;t=2.35,P=0.024;t=2.28,P=0.029),but there was no significant difference between the 12 months after operation of two groups(t=0.99,P=0.329;t=0.86,P=0.395).The immediately after operation,3 months after operation and 12 months after operation of DH,IFH and LL in the tw

关 键 词：腰椎 脊柱融合术 手术后并发症 椎间盘退行性变 再手术 治疗结果 

分 类 号：R687.3[医药卫生—骨科学]