| Stand-alone斜外侧椎间融合术应用于腰椎病变的早期结果和适应证探讨 |
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投稿时间：2024-06-20
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| 作者 | Author | 单位 | Address | E-Mail |
| 曾忠友 |
ZENG Zhong-you |
武警海警总队医院骨二科, 浙江 嘉兴 314000 |
The Second Department of Orthopaedics, Hospital of Coast Guard General Corps of Armed Police Forces, Jiaxing 314000, Zhejiang, China |
zjzengzy@126.com |
| 赵兴 |
ZHAO Xing |
浙江大学医学院附属邵逸夫医院骨科, 浙江 杭州 310016 |
Department of Orthopaedics, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310016, Zhejiang, China |
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| 俞伟 |
YU Wei |
武警海警总队医院骨二科, 浙江 嘉兴 314000 |
The Second Department of Orthopaedics, Hospital of Coast Guard General Corps of Armed Police Forces, Jiaxing 314000, Zhejiang, China |
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| 宋永兴 |
SONG Yong-xing |
武警海警总队医院骨二科, 浙江 嘉兴 314000 |
The Second Department of Orthopaedics, Hospital of Coast Guard General Corps of Armed Police Forces, Jiaxing 314000, Zhejiang, China |
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| 范顺武 |
FAN Shun-wu |
浙江大学医学院附属邵逸夫医院骨科, 浙江 杭州 310016 |
Department of Orthopaedics, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310016, Zhejiang, China |
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| 方向前 |
FANG Xiang-qian |
浙江大学医学院附属邵逸夫医院骨科, 浙江 杭州 310016 |
Department of Orthopaedics, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310016, Zhejiang, China |
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| 裴斐 |
PEI Fei |
武警海警总队医院骨二科, 浙江 嘉兴 314000 |
The Second Department of Orthopaedics, Hospital of Coast Guard General Corps of Armed Police Forces, Jiaxing 314000, Zhejiang, China |
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| 范时洋 |
FAN Shi-yang |
武警海警总队医院骨二科, 浙江 嘉兴 314000 |
The Second Department of Orthopaedics, Hospital of Coast Guard General Corps of Armed Police Forces, Jiaxing 314000, Zhejiang, China |
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| 宋国浩 |
SONG Guo-hao |
武警海警总队医院骨二科, 浙江 嘉兴 314000 |
The Second Department of Orthopaedics, Hospital of Coast Guard General Corps of Armed Police Forces, Jiaxing 314000, Zhejiang, China |
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| 期刊信息：《中国骨伤》2025年，第25卷，第5期，第454-464页 |
| DOI：10.12200/j.issn.1003-0034.20230538 |
| 基金项目:浙江省医药卫生科技计划项目(编号:2020KY968) |
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中文摘要:
目的:总结Stand-alone 斜外侧椎间融合术(oblique lateral interbody fusion,OLIF)在腰椎病变应用中的早期临床结果和安全性,探讨其手术适应证。
方法:回顾性分析两家医疗中心2014年10月至2018年12月采用Stand-alone OLIF治疗的92例腰椎病例。男30例,女62例;年龄32~83(61.20±12.94)岁;腰椎管狭窄症20例,腰椎间盘退行性病变15例,腰椎退行性滑脱11例,椎间盘源性腰痛6例,巨大型腰椎间盘突出症7例,原发性腰椎间隙炎13例,腰椎内固定术后邻椎病6例,退行性腰椎侧后凸畸形14例。术前双能X线检测骨密度T值-1~-2.4者31例,T值-2.5~-3.5者8例,其余骨密度正常。单节段68例,2节段9例,3节段12例,4节段3例;L1,2 1例,L2,3 4例,L3,4 10例,L4,553例,L2,3-L3,4 3例,L3,4-L4,5 6例,L1,2L2,3L3,4 1例,L1,2L3,4L4,5 1例,L2,3L3,4L4,5 10例,L1,2L2,3L3,4L4,5 3例。观察病例的临床和影像结果以及并发症情况。
结果:患者均获得随访,时间6~84(38.50±12.75)个月。手术时间40~140(60.92±27.40) min,术中出血量20~720(68.22±141.60) ml。椎间隙高度由术前的(9.23±1.94) mm,恢复至术后的 (12.68±2.01) mm,末次随访时的(9.11±1.72) mm,差异均有统计学意义差异(F=6.641,P=0.008),其中术后与术前比较,差异有统计学意义(t=9.27,P<0.0001),末次随访时与术后比较,差异有统计学意义(t=10.06,P<0.0001)。末次随访时融合器沉降分级:0级69例76节段,Ⅰ级17例43节段,Ⅱ级5例14节段,Ⅲ级1例1节段;按节段数统计:正常沉降占56.72%,异常沉降占43.28%。正常沉降组的骨密度T值-0.50±0.07优于异常沉降组-2.10±0.43,差异有统计学意义(χ2=2.275,P=0.014)。患者腰痛VAS由术前的(6.28±2.11)分降到末次随访时的(1.48±0.59)分,差异有统计学意义(t=8.56,P<0.05);Oswestry功能障碍指数(Oswestry disability index,ODI)由术前的(36.30±7.52)%恢复至末次随访时的(10.20±2.50)%,差异有统计学意义(t=7.79,P<0.0001)。术中血管损伤4例,终板损伤21例,合并椎体骨折4例。切口皮肤无坏死、无感染;术后左侧交感链损伤4例,一过性左侧屈髋无力4例,左大腿前外侧麻木伴股四头肌无力2例,不全型肠梗阻1例;8例因融合器沉降伴顽固性腰部酸痛,6例融合器沉降并横向移位经行后路椎弓根螺钉固定。并发症实际发生为38例,发生率41.3%。
结论:Stand-alone OLIF用于腰椎病变的融合获得了较好的早期结果,临床优势明显,但也存在较高的并发症,须慎重应用,建议逐步完善并明确手术适应证和具体病例选择标准。 |
| 【关键词】腰椎 内固定 椎间融合 斜外侧椎间融合术 并发症 再手术 手术适应证 |
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| Early results and indications of Stand-alone oblique lateral interbody fusion in lumbar lesions |
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ABSTRACT
Objective To summarize the early clinical
Results and safety of Stand-alone OLIF application of lumbar lesions,and explored its surgical indications.
Methods Total of 92 cases of lumbar spine lesions treated with Stand-alone OLIF at two medical centers from October 2014 to December 2018 were retrospectively analyzed,including 30 males and 62 females with an average age of (61.20±12.94) years old ranged from 32 to 83 years old. There were 20 cases of lumbar spinal stenosis,15 cases of lumbar disc degeneration,11 cases of lumbar degenerative spondylolisthesis,6 cases of discogenic low back pain,7 cases of giant lumbar disc herniation,13 cases of primary lumbar discitis,6 cases of adjacent vertebral disease after lumbar internal fixation surgery,and 14 cases of degenerative lumbar scoliosis. Pre-operative dual energy X-ray bone density examination 31 cases' T-values ranged from -1 to -2.4,8 cases' T-values ranged from -2.5 to -3.5,and the rest had normal bone density. The number of fusion segments:68 cases of single segment,9 cases of two segment,12 cases of three segment,and 3 cases of four segment. Fusion site:L1,2 1 case,L2,3 4 cases,L3,4 10 cases,L4,5 53 cases,L2,3-L3,4 3 cases,L3,4-L4,5 6 cases,L1,2L2,3L3,4 1 case,L1,2L3,4L4,5 1 case,L2,3L3,4L4,5 10 cases,L1,2L2,3L3,4L4,5 3 cases. The clinical Results and imaging Results of this group of cases were observed,as well as the complications.
Results The surgical time ranged from 40 to 140 minutes with an average of (60.92±27.40) minutes. The intraoperative bleeding volume was 20 to 720 ml with an average of (68.22±141.60) ml. The patients had a follow-up period of 6 to 84 months with an average of (38.50±12.75) months. The height of the intervertebral space recovered from (9.23±1.94) mm in preoperative to (12.68±2.01) mm in postoperative,and (9.11±1.72) mm at the last follow-up,there was a statistically significant difference(F=6.641,P=0.008);there was also a statistically significant difference between the postoperative and preoperative height of the intervertebral space(t=9.27,P<0.000 1);and there was also a statistically significant difference (t=10.06,P<0.000 1) between the last follow-up and postoperative height of the intervertebral space. At the last follow-up,cage subsidence grading was as follows:level 0 in 69 cases (76 segments),levelⅠin 17 cases (43 segments),level Ⅱin 5 cases (14 segments),and level Ⅲ in 1 case (1 segment);according to the number of segments,normal subsidence accounts for 56.72%,abnormal subsidence accounts for 43.28%. Bone mineral desity of normal subsidence groups was -0.50±0.07 whinch was better than that the abnormal subsidence groups -2.10±0.43,and the difference was statistically significant(χ2=2.275,P=0.014). As well as there was a statistically significant difference in the patient's VAS of backache from (6.28±2.11) in preoperative to (1.48±0.59) in last follow-up(t=8.56,P<0.05). The ODI recovered from (36.30±7.52)% before surgery to (10.20±2.50)% at the last follow-up,with a statistically significant difference (t=7.79,P<0.000 1). Complications involved 4 cases of intraoperative vascular injury,21 cases of endplate injury,and 4 cases of combined vertebral fractures. The incision skin has no necrosis or infection. There were 4 cases of left sympathetic chain injury,4 cases of transient left hip flexion weakness,2 cases of left thigh anterolateral numbness with quadriceps femoris weakness,and 1 case of incomplete intestinal obstruction;8 cases were treated with posterior pedicle screw fixation due to fusion cage settlement accompanied by stubborn lower back pain,and 6 cases were treated with fusion cage settlement and lateral displacement. According to the actual number of cases,there were 38 complications,with an incidence rate of 41.3%.
Conclusion The application of Stand alone OLIF in lumbar spine disease fusion has achieved good early results,with obvious clinical advantages,but also there are high probability of complications. It is recommended to choose carefully. It is necessary to continuously summarize and gradually clarify and complete the surgical indications and specific case selection criteria. |
| KEY WORDS Lumbar vertebra Internal fixation Intervertebral fusion Oblique lateral interbody fusion Complication Reoperation Surgical indications |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 曾忠友,赵兴,俞伟,宋永兴,范顺武,方向前,裴斐,范时洋,宋国浩.Stand-alone斜外侧椎间融合术应用于腰椎病变的早期结果和适应证探讨[J].中国骨伤,2025,25(5):454~464 |
| 英文格式: | ZENG Zhong-you,ZHAO Xing,YU Wei,SONG Yong-xing,FAN Shun-wu,FANG Xiang-qian,PEI Fei,FAN Shi-yang,SONG Guo-hao.Early results and indications of Stand-alone oblique lateral interbody fusion in lumbar lesions[J].zhongguo gu shang / China J Orthop Trauma ,2025,25(5):454~464 |
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