侧路-后路分期腰椎间融合术治疗退变性脊柱畸形  

Staged lateral-posterior lumbar interbody fusion for degenerative spinal deformity

作　　者：刘振磊 王凯 李康[1] 张雷 菅凤增[1] 吴浩[1] Zhen-lei LIU;Kai WANG;Kang LI;Lei ZHANG;Feng-zeng JIAN;Hao WU(Department of Neurosurgery,Xuanwu Hospital,Capital Medical University,Lab of Spinal Cord Injury and Functional Reconstruction,Neurospine Center,China International Neuroscience Institute(CHINA-INI),Beijing 100053,China)

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

出　　处：《中国现代神经疾病杂志》2024年第12期992-999,共8页Chinese Journal of Contemporary Neurology and Neurosurgery

基　　金：国家重点研发计划项目(项目编号:2023YFC2507700/2023YFC2507703);北京协和医院中央高水平医院临床科研专项(项目编号:2022-PUMCH-D-004)。

摘　　要：目的探讨侧路-后路分期腰椎间融合术治疗退变性脊柱畸形的有效性和安全性。方法纳入2021年12月至2022年6月在首都医科大学宣武医院行侧路-后路分期手术的22例退变性脊柱畸形患者,一期行侧路手术、二期行后路截骨术+内固定术,分别于术前和末次随访时(术后2年)采用视觉模拟评分(VAS)评估疼痛程度,Oswestry功能障碍指数(ODI)评估功能障碍程度,记录冠状位指标[包括冠状位平衡距离(CBD)、Cobb角]以及矢状位指标[包括矢状位垂直轴(SVA)、骨盆入射角(PI)、腰椎前凸角(LL)、骨盆入射角与腰椎前凸角匹配度(PI-LL)、骨盆倾斜角(PT)]。结果与术前相比,末次随访时(术后2年)腰痛VAS评分(Z=4.107,P=0.000)、腿痛VAS评分(Z=3.669,P=0.000)和ODI指数(Z=4.107,P=0.000)均减少,表明症状有效改善。经侧路-后路分期手术后,Cobb角(χ^(2)=40.364,P=0.000)、SVA(χ^(2)=22.455,P=0.000)、LL(χ^(2)=26.329,P=0.000)、PI-LL(χ^(2)=26.329,P=0.000)、PT(χ^(2)=12.091,P=0.002)均改善,与术前相比,一期侧路手术后Cobb角(Z=2.714,P=0.000)、LL(Z=3.844,P=0.000)、PI-LL(Z=3.844,P=0.000)、PT(Z=2.563,P=0.010)减小,二期后路微创手术后Cobb角(Z=6.332,P=0.000)、SVA(Z=4.673,P=0.000)、LL(Z=4.749,P=0.000)、PI-LL(Z=4.749,P=0.000)、PT(Z=3.317,P=0.001)进一步减小;与一期侧路手术后相比,二期后路微创手术后仅Cobb角(Z=3.618,P=0.000)、SVA(Z=3.015,P=0.003)减小,表明冠状位和矢状位失衡改善、畸形进一步矫正。2例(9.09%)术后1年出现近端交界性失败,4例(18.18%)术后2年出现椎间融合器沉降。结论侧路-后路分期腰椎间融合术在改善退变性脊柱畸形患者临床症状和恢复脊柱平衡方面显示出良好疗效,但手术长期稳定性和安全性尚待大样本队列研究验证。Objective:To evaluate the efficacy and safety of a staged lateral-posterior lumbar interbody fusion in the treatment of degenerative spinal deformity(DSD).Methods:A retrospective analysis was performed on 22 patients with degenerative spinal deformity who underwent staged lateral-posterior surgery at Xuanwu Hospital,Capital Medical University from December 2021 to June 2022.The first stage involved lateral surgery,while the second stage consisted of posterior osteotomy combined with internal fixation.Pain severity was assessed by Visual Analog Scales(VAS),and disability was evaluated by Oswestry Disability Index(ODI).Radiographic measurements included the coronal balance distance(CBD),Cobb angle,sagittal vertical axis(SVA),lumbar lordosis(LL),pelvic incidence(PI),pelvic incidence and lumbar lordosis(PI-LL)and pelvic tilt(PT).Results:Compared with preoperation,the VAS score of low back pain(Z=4.107,P=0.000),the VAS score of leg pain(Z=3.669,P=0.000)and the ODI(Z=4.107,P=0.000)were decreased at the last follow-up.After staged lateral-posterior surgery,Cobb angle(χ^(2)=40.364,P=0.000),SVA(χ^(2)=22.455,P=0.000),LL(χ^(2)=26.329,P=0.000),PI-LL(χ^(2)=26.329,P=0.000),PT(χ^(2)=12.091,P=0.002)improved.Compared with preoperation,Cobb angle(Z=2.714,P=0.000),LL(Z=3.844,P=0.000),PI-LL(Z=3.844,P=0.000),PT(Z=2.563,P=0.010)decreased after lateral surgery,while Cobb angle(Z=6.332,P=0.000),SVA(Z=4.673,P=0.000),LL(Z=4.749,P=0.000),PI-LL(Z=4.749,P=0.000),PT(Z=3.317,P=0.001)decrease after posterior surgery.Compared with the lateral surgery,only Cobb angle(Z=3.618,P=0.000)and SVA(Z=3.015,P=0.000)decreased after the posterior surgery.Proximal junction failure(PJF)occurred in 2 patients(9.09%)one year after surgery,and interbody fusion sink occurred in 4 patients(18.18%)2 years after surgery.Conclusions:The staged lateral-posterior lumbar interbody fusion demonstrated good efficacy in improving clinical symptoms and restoring spinal balance in patients with degenerative spinal deformity.However,the long-term stability and safety of

关 键 词：脊柱侧凸 椎间盘退行性变 腰椎 脊柱融合术 矫形外科手术 

分 类 号：R687.3[医药卫生—骨科学]