斜外侧腰椎椎间融合术后侧方融合的发生率及其相关因素分析  

Lateral fusion after oblique lateral lumbar interbody fusion:incidence,imaging characteristics,and contributing factors

作　　者：童勇骏 符楚迪 刘军辉[1] 黄保[1] 陈意磊[1] 单治[1] 张旭阳 范顺武[1] 赵凤东[1] Tong Yongjun;Fu Chudi;Liu Junhui;Huang Bao;Chen Yilei;Shan Zhi;Zhang Xuyang;Fan Shunwu;Zhao Fengdong(Department of Orthopaedics,Sir Run Run Shaw Hospital,School of Medicine,Zhejiang University,Hangzhou 310016,China;Department of Orthopaedics,the 903 Hospital of the Chinese people's Liberation Army,Hangzhou 310010,China;Department of Orthopaedics,Zhejiang Hospital,Hangzhou 310030,China)

机构地区：[1]浙江大学医学院附属邵逸夫医院骨科,杭州310016 [2]解放军联勤保障部队第九〇三医院骨科,杭州310010 [3]浙江医院骨科,杭州310030

出　　处：《中华骨科杂志》2025年第7期420-428,共9页Chinese Journal of Orthopaedics

摘　　要：目的探讨斜外侧腰椎椎间融合(oblique lateral interbody fusion,OLIF)术后椎间融合的特征性表现及可能影响融合方式的相关因素。方法回顾性分析2017年7月至2023年9月在浙江大学医学院附属邵逸夫医院接受OLIF手术治疗的209例患者的资料,男125例、女84例,年龄(64.2±9.8)岁(范围19~80岁)。209例(338个节段)中单纯融合器OLIF(OLIF stand alone,OLIF-SA)102例(159个节段)、OLIF联合后路椎弓根螺钉固定(OLIF and pedicle screw fixation,OLIF-PSF)107例(179个节段)。通过手术记录获取固定方式、融合节段数、手术侧别、融合器高度和宽度等资料,通过影像学资料获取术前骨赘等级、术前CT骨性终板亨氏单位(HU)值、融合器位置等资料,评估融合率、融合方式及融合器沉降情况,评估上述因素对融合方式的影响。手术前后及术后1年时采用Oswestry功能障碍指数(Oswestry disability index,DI)及疼痛视觉模拟评分(visual analogue scale,VAS)评估临床疗效。结果OLIF术后总体融合率为98.2%(332/338),未融合率为1.8%(6/338)。OLIF术后出现侧方融合的总体比例为40.2%(136/338)。OLIF-SA组侧方融合占50.3%(80/159)、中央型融合占49.7%(79/159)、未融合为0;OLIF-PSF组分别为31.3%(56/179)、65.4%(117/179)和3.3%(6/179),差异有统计学意义(P<0.05)。术前骨赘、术前骨性终板高HU值与侧方融合存在相关性(P<0.05),融合器高度和宽度、融合器前后及左右位置在不同融合方式间的差异无统计学意义(P>0.05)。融合器无沉降占为61.5%(208/338)、融合器锚定占24.5%(83/338)、1级以上沉降占14.0%(47/338)。侧方融合组无沉降、锚定及1~3级沉降分别占67.6%(92/136)、21.3%(29/136)、7.4%(10/136)、3.9%(4/136)和0.7%(1/136),中央型融合组分别为59.2%(116/196)、27.6%(54/196)、9.2%(18/196)、2.5%(5/196)和1.3%(3/196),差异有统计学意义(P<0.05);未融合组2级和3级沉降各3个节段,2级和3级沉降占比高于侧方融合组和中央型融合组�Objective To evaluate the characteristic manifestations of lumbar fusion following oblique lateral interbody fusion(OLIF),determine the specific incidence of these patterns,and the identify factors associated with fusion characteristics.Methods This retrospective study analyzed 209 patients who underwent OLIF surgery at Sir Run Run Shaw Hospital,Zhejiang University School of Medicine,between July 2017 and September 2023.The cohort had a mean age of 64.2±9.8 years and included 125 males and 84 females.A total of 338 lumbar segments were assessed,comprising 159 segments treated with stand-alone OLIF(OLIF-SA)and 179 segments treated with OLIF combined with posterior pedicle screw fixation(OLIF-PSF).Inclusion criteria were:patients aged 18-80 years who underwent OLIF with complete radiographic records.Surgical parameters,including fixation method,number of fused segments,surgical approach,and cage dimensions(height and width),were obtained from operative records.Radiographic evaluation included preoperative osteophytes,Hounsfield unit(HU)values of endplates,and cage positioning.Fusion rate,fusion pattern(lateral vs.central),cage subsidence,and related influencing factors were assessed.Clinical outcomes were measured via the Oswestry disability index(ODI)and visual analog scale(VAS)preoperatively,immediately postoperatively,and at 1-year follow-up.Results The overall fusion rate was 98.2%(332/338),with a non-union rate of 1.8%(6/338).The incidence of lateral fusion was 40.2%(136/338).In the OLIF-SA group,lateral and central fusion rates were 50.3%(80/159)and 49.7%(79/159),respectively,with no cases of non-union.In the OLIF-PSF group,lateral fusion occurred in 31.3%(56/179),central fusion in 65.4%(117/179),and non-union in 3.3%(6/179),with statistically significant differences between groups(P<0.05).Preoperative osteophytes and higher endplate HU values were significantly associated with lateral fusion(P<0.05).However,cage dimensions and cage position(anterior-posterior and lateral placement)were not significantly ass

关 键 词：腰椎 椎间盘退行性变 脊柱融合术 侧方融合 中央型融合 

分 类 号：R687.3[医药卫生—骨科学]