斜外侧椎间融合联合侧方钢板固定治疗单节段腰椎退变性疾病的短期疗效  

Short-term efficacy of oblique lateral interbody fusion combined with lateral plate fixation in treatment of single-level lumbar degenerative disease

作　　者：刘晓印 张建群[1] 陈振[2] 梁思敏[1] 王志强 马宗军[1] 马荣[2] 戈朝晖[1] Liu Xiaoyin;Zhang Jianqun;Chen Zhen;Liang Simin;Wang Zhiqiang;Ma Zongjun;Ma Rong;Ge Zhaohui(Department of Orthopedics,General Hospital of Ningxia Medical University,Yinchuan 750003,Ningxia Hui Autonomous Region,China;Ningxia Medical University,Yinchuan 750004,Ningxia Hui Autonomous Region,China)

机构地区：[1]宁夏医科大学总医院骨科,宁夏回族自治区银川市750003 [2]宁夏医科大学,宁夏回族自治区银川市750004

出　　处：《中国组织工程研究》2025年第3期531-537,共7页Chinese Journal of Tissue Engineering Research

基　　金：宁夏医科大学总医院2022年医工专项资助项目(NYDZY-005),项目负责人:戈朝晖;2020宁夏重点研发计划项目(2020BEG03034),项目负责人:戈朝晖。

摘　　要：背景:单纯斜外侧椎间融合术融合器沉降并发症率高,辅助后方的固定可以提供稳定的支撑,但术中体位变化、双切口都弱化了该技术的微创优势。斜外侧椎间融合术联合侧方钢板固定可以实现一期同切口完成减压,同时侧方内固定提供了稳定支撑。目的:分析斜外侧椎间融合联合侧方钢板固定治疗单节段腰椎退变性疾病的短期临床疗效。方法:收集2020年5月至2022年10月应用斜外侧椎间融合联合侧方钢板固定治疗单节段腰椎退变性疾病34例患者的临床资料,其中男14例,女20例;年龄41-72岁,平均(58.6±9.9)岁;腰椎滑脱症(Ⅰ度)11例,腰椎间盘突出症并节段不稳7例,腰椎管狭窄症16例。记录患者手术时间、出血量及并发症。评估术前、术后3个月及末次随访腰痛及双下肢放射痛疼痛目测类比评分和Oswestry功能障碍指数评分;测量并观察手术前后硬膜囊面积、椎间隙高度及椎间融合情况。结果与结论:(1)34例患者随访14-36个月,平均(21.3±5.2)个月;(2)手术时间50-92 min,平均(68.5±11.1)min;术中出血量50-170 mL,平均(71.6±25.3)mL;(3)与术前相比,术后3个月及末次随访目测类比评分和Oswestry功能障碍指数评分均显著降低,差异均有显著性意义(P<0.001),最大Oswestry功能障碍指数评分改善近50%;(4)术后半年随访所有患者均达到骨性融合,总体并发症发生率为21%(7/34),其中钢板移位1例、融合器下沉3例、术侧腰大肌无力1例、术侧大腿前侧疼痛2例;(5)提示斜外侧椎间融合联合侧方钢板固定治疗单节段腰椎退变性疾病,具有出血量少、手术时间短、术后恢复快的特点,短期临床疗效显著且可提供一定稳定支撑,长期疗效有待进一步随访观察。BACKGROUND:Stand-alone oblique lateral interbody fusion has a high rate of complications of fusion segment sink.Oblique lateral interbody fusion with posterior fixation can provide stable support,but intraoperative position changes and double incisions weaken the advantages of this technique.Oblique lateral interbody fusion combined with lateral plate fixation can achieve one-stage decompression in the same incision,while the lateral internal fixation provides stable support.OBJECTIVE:To analyze the short-term efficacy of oblique lateral interbody fusion combined with lateral plate fixation in the treatment of single-level lumbar degenerative disease.METHODS:The clinical data of 34 patients with single-level lumbar degenerative disease treated with oblique lateral interbody fusion combined with lateral plate fixation were collected from May 2020 to October 2022.Among them,14 were males and 20 were females aged from 41 to 72 years at the mean age of(58.6±9.9)years.There were 11 cases of lumbar spondylolisthesis(I°),7 cases of lumbar disc herniation with segmental instability,and 16 cases of lumbar spinal stenosis.Operation time,blood loss,and complications were recorded.Visual analog scale scores of lumbago,radiative pain of both lower limbs,and Oswestry disability index scores were evaluated before surgery,3 months after surgery,and the last follow-up.Dural sac cross-sectional area,intervertebral height,and intervertebral fusion were measured and observed.RESULTS AND CONCLUSION:(1)The 34 patients were followed up for 14-36 months,with an average of(21.3±5.2)months.(2)The operation time ranged from 50 to 92 minutes,with an average of(68.5±11.1)minutes.Intraoperative blood loss was 50-170 mL,with an average of(71.6±25.3)mL.(3)Compared with the preoperative results,the visual analog scale scores and Oswestry disability index scores were significantly decreased at 3 months after surgery and at the last follow-up(P<0.001),and the maximum Oswestry disability index scores were improved by nearly 50%.(4)Bone fusion

关 键 词：斜外侧椎间融合术 脊柱融合术 腰椎退变性疾病 侧方钢板 内固定 临床疗效 

分 类 号：R459.9[医药卫生—治疗学] R318[医药卫生—临床医学] R687.3