斜外侧腰椎椎间融合术联合前路内固定治疗退行性腰椎滑脱症的疗效分析  

An analysis on the effect of oblique lateral interbody fusion combined with anterolateral screw fixation on treatment of degenerative lumbar spondylolisthesis

作　　者：李柱海 曾建成[1] 王贤帝[1] 谢天航 林润 黄石书[1] LI Zhu-hai;ZENG Jian-cheng;WANG Xian-di(Department of Orthopedics,West China Hospital,Sichuan University,Chengdu 610041,China;Department of Spine Surgery,the People′s Hospital of Guangxi Zhuang Autonomous Region,Nanning 530021,China)

机构地区：[1]四川大学华西医院骨科,成都610041 [2]广西壮族自治区人民医院脊柱外科,南宁530021

出　　处：《中国临床新医学》2023年第3期213-218,共6页CHINESE JOURNAL OF NEW CLINICAL MEDICINE

基　　金：四川省科技厅重点研发项目(编号:2022YFS0051);广西卫生健康委科研课题(编号:Z20210722)。

摘　　要：目的分析斜外侧腰椎椎间融合术(OLIF)联合前路内固定治疗退行性腰椎滑脱症(DLS)的疗效。方法回顾性分析2018年1月至2021年8月在四川大学华西医院行OLIF联合前路内固定治疗的76例腰4-5节段DLS患者的临床资料。记录手术时间、术中出血量、住院时间、术后并发症情况等。比较术前、术后3个月、术后12个月随访时的腰腿痛视觉模拟量表(VAS)评分、Oswestry功能障碍指数(ODI)评分。于术前、术后1 d、术后3个月、术后12个月随访时在X线片上测量腰椎前凸角(LL)、手术节段前凸角(SL),在CT矢状面重建图像测量椎间隙高度(DH)、滑脱距离(SD)、融合器沉降距离,计算滑脱改善率,评估融合情况及融合率。结果手术时间为(99.2±13.1)min,术中出血量为(37.8±7.1)ml。所有患者随访1年以上。术后3个月、12个月腰痛VAS评分、腿痛VAS评分、ODI评分均较术前显著改善,差异有统计学意义(P<0.05)。术后1 d、3个月、12个月的LL、SL、DH、SD较术前显著改善,差异有统计学意义(P<0.05),术后3个月、12个月时DH较术后1 d减小,差异有统计学意义(P<0.05)。2例患者术中出现腰5椎体上终板损伤,17例患者术后出现融合器沉降,2例患者出现大腿前侧麻木。术后12个月共有70例患者实现椎间植骨融合,融合率为92.11%。结论OLIF联合前路内固定治疗DLS临床疗效满意,能够有效矫正腰椎前凸及节段前凸,椎体滑脱部分复位,椎管减压效果确切,是治疗DLS安全、有效、微创的术式。Objective To analyse the effect of oblique lateral interbody fusion(OLIF)combined with anterolateral screw fixation on treatment of degenerative lumbar spondylolisthesis(DLS).Methods A retrospective analysis was performed on 76 patients who underwent OLIF combined with anterolateral screw fixation for DLS at the L 4-5 levels in West China Hospital,Sichuan University between January 2018 and August 2021.The operation time,intraoperative blood loss,hospital stay and postoperative complications were recorded.The Visual Analogue Scale(VAS)score and Oswestry Disability Index(ODI)score for assessing the low back and legs were compared among the follow-up patients before operation,3 months and 12 months after operation.The radiographic parameters including lumbar lordosis(LL)and segmental lordosis(SL),and disc height(DH),slip distance(SD)and cage subsidence in the computed tomography(CT)sagittal reconstruction image were measured before operation,and at the follow-up time of 1 day,3 months and 12 months after operation.The slip correction rate was calculated,and the fusion condition and fusion rate were evaluated.Results The mean operation time was(99.2±13.1)minutes,and the intraoperative blood loss was(37.8±7.1)ml.All the patients were followed up for more than 1 year.The VAS scores for lumbago,the VAS scores for leg pain and the ODI scores in the patients were significantly improved 3 months and 12 months after operation compared with those before operation,and the differences were statistically significant(P<0.05).The LL,SL,DH and SD were significantly improved 1 day,3 months and 12 months after operation compared with those before operation,and the differences were statistically significant(P<0.05).The DH was decreased 3 months and 12 months after operation compared with that 1 day after operation,and the difference was statistically significant(P<0.05).Intraoperative endplate injury at L 5 vertebra was observed in 2 patients.A total of 17 patients developed cage subsidence,and other 2 patients suffered from numbn

关 键 词：斜外侧腰椎椎间融合术 退行性腰椎滑脱症 前路内固定 融合器沉降 

分 类 号：R681.5[医药卫生—骨科学]