斜外侧腰椎椎体间融合联合经皮内镜下减压后路固定治疗腰椎滑脱合并腰椎管狭窄症  

Oblique lumbar interbody fusion combined with percutaneous endoscopic decompression and posterior fixation for the treatment of lumbar spondylolisthesis accompanied with lumbar spinal stenosis

作　　者：徐国康 苏棋 屠玉兰 陈飞 罗金伟 沈童 陈子航 张弘 刘怿 章鑫隆 Xu Guokang;Su Qi;Tu Yulan;Chen Fei;Luo Jinwei;Shen Tong;Chen Zihang;Zhang Hong;Liu Yi;Zhang Xinlong(Department of Orthopaedics,The First People Hospital of Fuyang District,Hangzhou 311400,China)

机构地区：[1]杭州市富阳区第一人民医院骨科,杭州311400

出　　处：《中华骨科杂志》2023年第9期550-558,共9页Chinese Journal of Orthopaedics

摘　　要：目的探讨斜外侧腰椎椎体间融合(oblique lumbar interbody fusion,OLIF)联合经皮椎间孔入路内镜(percutaneous transforaminal endoscopic decompression,PTED)下椎管减压后路(Wiltse入路)椎弓根螺钉固定治疗腰椎滑脱合并腰椎管狭窄症的疗效。方法2017年6月至2022年2月采用OLIF结合PTED减压后路椎弓根固定治疗腰椎滑脱合并腰椎管狭窄症患者103例,男50例、女53例;年龄(64.1±5.2)岁(范围42~87岁)。均为单节段,L4,583例、L3,417例、L2,33例。初次手术94例,既往后路椎板开窗椎间盘摘除术后症状再发行翻修手术9例。采用疼痛视觉模拟评分(visual analogue scale,VAS)评估腰痛及下肢痛程度,采用Oswestry功能障碍指数(Oswestry disability index,ODI)评估腰椎功能,分别记录术前,出院时,术后1、3、6个月及末次随访时的腰痛、下肢痛VAS及ODI。末次随访时采用MacNab标准评估临床疗效。影像学评价包括手术前后侧位X线片测量椎间隙前后缘高度、手术节段角及滑脱百分比,轴位MRI测量椎管面积。结果所有患者均一期顺利完成手术,手术时间(177.7±21.5)min(范围155~220 min),术中出血量(55.9±18.3)ml(范围30~150 ml)。术后随访时间(15.1±2.6)个月(范围6~36个月)。出院时、术后1、3、6个月及末次随访时与术前腰痛VAS、下肢痛VAS及ODI的差异均有统计学意义(F=508.25,F=1524.82,F=1148.68,P<0.001)。末次随访时按MacNab标准,优85例、良14例、可4例,优良率为96.1%(99/103)。术前手术节段椎间隙前缘高度为(11.93±3.17)mm,后缘高度为(7.21±2.03)mm,手术节段角为6.15°±3.99°,滑脱百分比为23.66%±7.79%,椎管面积为(57.63±28.91)mm^(2);术后即刻椎间隙前缘高度为(15.23±2.97)mm,后缘高度为(9.32±2.31)mm,手术节段角为14.36°±4.18°,滑脱百分比为3.89%±3.11%,椎管面积为(113.37±47.27)mm^(2),手术前后的差异均有统计学意义(t=7.84,t=7.07,t=14.91,t=27.62,t=9.68,P<0.001)。所有病例均于术后6~12个月获得骨�Objective To investigate the efficacy of oblique lumbar interbody fusion(OLIF)combined with percutaneous transforaminal endoscopic decompression(PTED)and posterior pedicle fixation through Wiltse approach in the treatment of lumbar spondylolisthesis accompanied with lumbar spinal stenosis.Methods From June 2017 to February 2022,103 patients(50 males and 53 females)of lumbar spondylolisthesis accompanied with lumbar spinal stenosis were performed with OLIF combined with PTED and posterior pedicle fixation.The mean age was 64.1±5.2 years(range,42-87 years).All involved cases were single-segment and included 83 cases of L4,5,17 cases of L3,4,and 3 cases of L2,3.Among them,94 cases were performed for the first time,and other 9 were revision surgery treated by posterior lumbar laminectomy previously.The visual analog scale(VAS)was used to evaluate the low back pain and leg pain,and the Oswestry disability index(ODI)was used to evaluate the lumbar function.The VAS and ODI scores were recorded respectively before the operation,at discharge,1,3,6 months after the operation and at the last follow-up.Macnab criteria was used to evaluate the clinical efficacy at the last follow-up.At the same time,imaging measurements were conducted,including the anterior and posterior disc height,segmental lordotic angle,percentage of slip on lateral X-ray film and the vertebral canal area on axial MRI before and after surgery.Results All of 103 patients were successfully operated in one stage with an average operation time of 177.7±21.5 min(range,155-220 min),and an average intraoperative blood loss of 55.9±18.3 ml(range,30-150 ml).The mean follow-up time were 15.1±2.6 months(range,6-36 months).There were significant differences in both VAS scores of back and leg and ODI scores at each postoperative time point when compared with preoperative(F=508.25,F=1524.82,F=1148.68,P<0.001).Macnab criteria of the last follow-up was evaluated as follow:excellent in 85 cases,good in 14,fair in 4,and the excellent and good rate was 96.1%.The radiogr

关 键 词：腰椎 脊椎滑脱 椎管狭窄 脊柱融合术 内窥镜检查 

分 类 号：R687.3[医药卫生—骨科学]