| 单一体位O形臂导航下斜外侧椎间融合术联合后微创经皮椎弓根钉内固定术治疗腰椎滑脱 |
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投稿时间：2025-03-11
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| 作者 | Author | 单位 | Address | E-Mail |
| 屠凯凯 |
TU Kai-kai |
杭州市萧山区中医院, 浙江 杭州 311201 |
Xiaoshan District Hospital of Traditional Chinese Medicine, Hangzhou 311201, Zhejiang, China |
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| 费慧 |
FEI Hui |
浙江萧山医院医共体总院宁围分院, 浙江 杭州 311201 |
Ningwei Branch of Zhejiang Xiaoshan Hospital, Hangzhou 311201, Zhejiang, China |
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| 楼宇梁 |
LOU Yu-liang |
杭州市萧山区中医院, 浙江 杭州 311201 |
Xiaoshan District Hospital of Traditional Chinese Medicine, Hangzhou 311201, Zhejiang, China |
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| 王灿锋 |
WANG Can-feng |
杭州市萧山区中医院, 浙江 杭州 311201 |
Xiaoshan District Hospital of Traditional Chinese Medicine, Hangzhou 311201, Zhejiang, China |
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| 李长明 |
LI Chang-ming |
杭州市萧山区中医院, 浙江 杭州 311201 |
Xiaoshan District Hospital of Traditional Chinese Medicine, Hangzhou 311201, Zhejiang, China |
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| 周利申 |
ZHOU Li-shen |
杭州市萧山区中医院, 浙江 杭州 311201 |
Xiaoshan District Hospital of Traditional Chinese Medicine, Hangzhou 311201, Zhejiang, China |
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| 洪锋 |
HONG Feng |
杭州市萧山区中医院, 浙江 杭州 311201 |
Xiaoshan District Hospital of Traditional Chinese Medicine, Hangzhou 311201, Zhejiang, China |
570921651@qq.com |
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| 期刊信息：《中国骨伤》2025年，第25卷，第5期，第447-453页 |
| DOI：10.12200/j.issn.1003-0034.20250087 |
| 基金项目:2024年度浙江省市农业与社会发展领域公益性科研引导项目(编号:20241029Y118);2025年度浙江省中医药科技计划项目(编号:2025ZX072);2025年度浙江省中医药科技计划项目(编号:2025ZX070) |
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中文摘要:
目的:探讨单一体位下O形臂X线机导航辅助斜外侧椎间融合术(oblique lateral interbody fusion,OLIF)联合后微创经皮椎弓根钉内固定术(percutaneous pedicle screw fixation,PPS)在治疗腰椎滑脱中的早期临床疗效。
方法:回顾性分析2021年4月至2023年6月接受单一体位下O形臂X线机导航辅助斜外侧入路腰椎融合术联合后微创经皮椎弓根钉内固定术(OLIF-PPS)治疗的腰椎滑脱患者22例,男11例,女11例;年龄49~80(64.6±1.5)岁;患者术前均有腰骶部疼痛、下肢放射痛麻木等症状,保守治疗效果不佳。记录患者手术时间、术中出血量、住院时间及术后并发症情况;于术前、术后3 d及末次随访时采用视觉模拟评分量表(visual analogue scale,VAS)、Oswestry功能障碍指数(Oswestry disability index,ODI)评分以评估临床治疗效果;同期拍摄站立位腰椎正侧位X线片,测量和评估椎间隙高度、滑脱程度、椎体复位率、椎弓根螺钉优良率及融合器沉降等情况。
结果:所有患者手术顺利完成,术后均获随访,时间18~36(27.1±2.2)个月。手术时间60~93(76.1±12.2) min,术中出血量40~113(86.3±32.2) ml,住院时间(7.1±1.2) d。22例患者VAS由术前(7.2±0.7)分降低至术后3 d的(2.3±0.5)分、末次随访时(1.7±0.2)分,术后VAS均较术前好转,且末次随访优于术后3 d,差异均有统计学意义(P<0.05)。ODI由术前(68.5±7.2)%提升至术后3 d的(30.3±3.1)%、末次随访时(16.6±1.6)%,术后ODI均较术前好转,末次随访优于术后3 d,差异均有统计学意义(P<0.05)。椎间隙高度由术前(8.5±1.7) mm提升至术后3 d的(18.1±1.4) mm、末次随访时(17.2 ±1.1) mm,术后椎间隙高度均较术前提高,差异均有统计学意义(P<0.05)。椎体术前滑脱程度(24.1±4.6)%改善至术后3 d的(10.3±4.2)%、末次随访时(10.1±3.2)%,术后椎体滑脱均较术前改善,差异均有统计学意义(P<0.05)。22例患者共置入88枚椎弓根螺钉,优良率98%(86/88)。1例患者术后出现左大腿前内侧疼痛,2例患者术后出现短暂的左侧屈髋无力,均在随访时恢复。所有患者未出现切口血肿或感染、螺钉松动、融合器沉降等情况。
结论:单一体位下O形臂X线机辅助斜外侧入路腰椎融合术联合后微创经皮椎弓根钉内固定术(OLIF-PPS)治疗的腰椎滑脱的早期临床疗效满意,具有微创、临床疗效佳、椎体复位率好及并发症少等优点。 |
| 【关键词】腰椎滑脱 斜外侧椎间融合术 经皮椎弓根钉 脊柱微创手术 新手术技巧 |
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| Single-position O-arm X-ray navigation assisted oblique lateral interbody fusion combined with minimally invasive percutaneous pedicle nail internal fixation for lumbar spondylolisthesis |
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ABSTRACT
Objective To investigate the early clinical efficacy of single-position O-arm navigation-assisted oblique lateral interbody fusion(OLIF) combined with minimally invasive percutaneous pedicle screw fixation(PPS) in the treatment of lumbar spondylolisthesis.
Methods A retrospective analysis was conducted on 22 patients with lumbar spondylolisthesis who underwent OLIF-PPS surgery including 11 males and 11 females with a mean age of (64.6±1.5) years old ranging from 49 to 80 years old between April 2021 and June 2023. All patients presented with lumbosacral pain,lower limb radiating pain,numbness,and had poor responses to conservative treatment. Surgical time,intraoperative blood loss,hospital stay,and postoperative complications were recorded. Clinical outcomes were evaluated using the visual analogue scale(VAS) and Oswestry disability index(ODI) preoperatively at 3 days after operation and the final follow-up. Standing lumbar anteroposterior and lateral X-rays were performed to measure disc height(DH),slippage degree,vertebral reduction rate,pedicle screw accuracy,and cage subsidence.
Results All surgeries were successfully completed with a mean follow-up of (27.1±2.2) months (range 18 to 36 months). The mean surgical time was (76.1±12.2) min (range 60 to 93 min),intraoperative blood loss was (86.3±32.2) ml (range 40 to 113 ml),and hospital stay was (7.1±1.2) days. Postoperative VAS significantly improved from (7.2±0.7) preoperatively to (2.3±0.5) at 3 days after operation and (1.7±0.2) at the final follow-up (P<0.05). ODI decreased from (68.5±7.2)% preoperatively to (30.3±3.1)% at 3 days after operation and (16.6±1.6)% at the final follow-up (P<0.05). DH increased from (8.5±1.7) mm preoperatively to (18.1±1.4) mm at 3 days after operation and (17.2±1.1) mm at the final follow-up (P<0.05). Slippage degree improved from (24.1±4.6)% preoperatively to (10.3±4.2)% at 3 days after operation and (10.1±3.2)% at the final follow-up (P<0.05). A total of 88 pedicle screws were implanted with an excellent rate of 98% (86/88). Complications included transient left hip flexion weakness (2 cases) and left anteromedial thigh pain (1 case),all resolved during follow-up. No incision hematoma,infection,screw loosening,or cage subsidence occurred.
Conclusion Single-position O-arm navigation-assisted OLIF combined with PPS demonstrates satisfactory early clinical efficacy for lumbar spondylolisthesis,with advantages including minimal invasiveness,significant pain relief,effective vertebral reduction,and low complication rates. |
| KEY WORDS Lumbar spondylolisthesis Oblique lateral interbody fusion Percutaneous pedicle screw Minimally invasive spine surgery Novel surgical technique |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 屠凯凯,费慧,楼宇梁,王灿锋,李长明,周利申,洪锋.单一体位O形臂导航下斜外侧椎间融合术联合后微创经皮椎弓根钉内固定术治疗腰椎滑脱[J].中国骨伤,2025,25(5):447~453 |
| 英文格式: | TU Kai-kai,FEI Hui,LOU Yu-liang,WANG Can-feng,LI Chang-ming,ZHOU Li-shen,HONG Feng.Single-position O-arm X-ray navigation assisted oblique lateral interbody fusion combined with minimally invasive percutaneous pedicle nail internal fixation for lumbar spondylolisthesis[J].zhongguo gu shang / China J Orthop Trauma ,2025,25(5):447~453 |
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