| 斜外侧椎间融合术通道技术在腰椎感染中的应用 |
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Received:February 27, 2025
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| 作者 | Author | 单位 | Unit | E-Mail |
| 李生鋆 |
LI Sheng-yun |
浙江大学医学院附属邵逸夫医院新疆兵团阿拉尔医院骨科, 新疆 阿拉尔 843300
浙江大学医学院附属邵逸夫医院骨科, 浙江 杭州 310016 |
Department of Orthopaedics Surgery, Sir Run Run Shaw Hospital, Alaer Hospital, Zhejiang University School of Medicine, Alaer 843300, Xinjiang, China
Department of Orthopedic Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310016, Zhejiang, China |
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| 李俊 |
LI Jun |
浙江大学医学院附属邵逸夫医院新疆兵团阿拉尔医院骨科, 新疆 阿拉尔 843300 |
Department of Orthopaedics Surgery, Sir Run Run Shaw Hospital, Alaer Hospital, Zhejiang University School of Medicine, Alaer 843300, Xinjiang, China |
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| 张晓锐 |
ZHANG Xiao-rui |
浙江大学医学院附属邵逸夫医院新疆兵团阿拉尔医院骨科, 新疆 阿拉尔 843300 |
Department of Orthopaedics Surgery, Sir Run Run Shaw Hospital, Alaer Hospital, Zhejiang University School of Medicine, Alaer 843300, Xinjiang, China |
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| 宋杰 |
SONG Jie |
浙江大学医学院附属邵逸夫医院新疆兵团阿拉尔医院骨科, 新疆 阿拉尔 843300 |
Department of Orthopaedics Surgery, Sir Run Run Shaw Hospital, Alaer Hospital, Zhejiang University School of Medicine, Alaer 843300, Xinjiang, China |
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| 徐修磊 |
XU Xiu-lei |
浙江大学医学院附属邵逸夫医院新疆兵团阿拉尔医院骨科, 新疆 阿拉尔 843300 |
Department of Orthopaedics Surgery, Sir Run Run Shaw Hospital, Alaer Hospital, Zhejiang University School of Medicine, Alaer 843300, Xinjiang, China |
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| 吕凯 |
LYU Kai |
浙江大学医学院附属邵逸夫医院手术室, 浙江 杭州 310016 |
Operating room, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310016, Zhejiang, China |
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| 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 Orthopedic Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310016, Zhejiang, China |
zhaox@zju.edu.cn |
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| 期刊信息：《中国骨伤》2025年25卷，第5期，第473-481页 |
| DOI：10.12200/j.issn.1003-0034.20240512 |
| 基金项目:浙江省教育厅项目(编号:Y202146204) |
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目的:探讨斜外侧椎间融合术(oblique lateral interbody fusion,OLIF)通道技术联合椎弓根钉内固定治疗单节段腰椎间隙/椎体感染的疗效及安全性。
方法:回顾性分析2021年1月至2022年12月因腰椎感染行手术治疗的23例患者,按照手术方式分为OLIF通道组与传统开放手术组,其中OLIF通道组16例,男9例,女7例,年龄(68.5±12.1)岁;传统开放手术组7例,男4例,女3例,年龄(75.0±3.2)岁。比较两组手术时间、术中出血量、住院时间、手术切口长度,术前、术后1周、3个月采用疼痛视觉模拟评分(visual analogue scale,VAS)、日常生活活动能力(activities of daily living,ADL)评分、Oswestry功能障碍指数(Oswestry disability index,ODI)进行功能评价,末次随访时用腰椎CT矢状位重建图像评估椎间融合情况。
结果:OLIF通道组与开放手术组比较,手术时间(209.9±31.5) min vs. (246.0±42.7) min,术中出血量(225.6±91.1) ml vs. (364.2±74.8) ml,手术切口长度(6.1±1.2) cm vs. (14.0±1.4) cm,差异均有统计学意义(P<0.05)。术前、术后1周、3个月,腰部VAS:OLIF组(6.3±0.6)、(2.8±0.7)、(1.1±0.5)分,传统开放手术组(6.4±0.6)、(3.4±0.5)、(1.2±0.3)分;ADL评分:OLIF组(45.0±4.5)、(60.3±4.3)、(94.1±4.2)分;开放组(46.4±5.6)、(60.7±4.5)、(92.9±4.9)分;ODI:OLIF组(86.3±2.9)%、(69.5±4.1)%、(23.0±3.2)%;开放组(87.3±3.8)%、(69.8±4.2)%、(23.8±3.6)%,均有显著改善。术后3个月,C反应蛋白(C-reactive protein, CRP)、血小板压积(plateletcrit,PCT)、红细胞沉降率(erythrocyte sedimentation rate,ESR)均较术前显著下降,CRP及PCT均恢复至正常,部分患者ESR仍然略有增高。末次随访CT提示,所有患者手术节段上下终板间均有连续骨小梁形成,融合时间(8.7±4.5)个月。
结论:OLIF通道技术联合后路内固定是一种微创、有效的治疗方式,能够有效控制感染,改善疼痛及患者生活质量,相较于传统开放手术,具有微创、手术时间短、出血量少等优势。 |
| [关键词]:腰椎 内固定 椎间融合 感染 斜外侧椎间融合术 微创 |
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| Application of oblique lateral interbody fusion channel technique in lumbar infection |
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Abstract:
Objective To investigate the efficacy and safety of oblique lateral interbody fusion(OLIF) channel technique combined with pedicle screw internal fixation in the treatment of single-segment lumbar intervertebral space/vertebral body infection.
Methods A retrospective analysis was conducted on 23 patients who underwent surgical treatment for lumbar infection from January 2021 to December 2022. The patients were divided into the OLIF channel group and the traditional open surgery group according to the surgical methods. There were 16 cases in the OLIF channel group,including 9 males and 7 females,with an average age of (68.5±12.1) years old;there were 7 cases in the traditional open surgery group,including 4 males and 3 females,with an average age of (75.0±3.2) years old. The operation time,intraoperative blood loss,hospital stay,incision length,visual analogue scale(VAS),activities of daily living (ADL) score,Oswestry disability index (ODI),erythrocyte sedimentation rate(ESR),C-reactive protein(CRP) before and 1 week and 3 months after the operation,and the intervertebral fusion status on the last follow-up CT were compared between the two groups.
Results Compared with the open surgery group,the OLIF channel group had shorter operation time (209.87±31.5) min vs. (246.0±42.7) min,less intraoperative blood loss (225.625±91.1) ml vs. (364.2±74.8) ml,and shorter incision length (6.1±1.2) vs. (14.0±1.4) cm,and the differences were statistically significant(P<0.05). Before and 1 week and 3 months after the operation,the lumbar VAS in the OLIF group were (6.3±0.6),(2.8±0.7),(1.1±0.5),and those in the traditional open surgery group were (6.4±0.6),(3.4±0.5),(1.2±0.3);the ADL scores in the OLIF group were (45.0±4.5),(60.3±4.3),(94.1±4.2),and those in the open group were (46.4±5.6),(60.7±4.5),(92.9±4.9); the ODI scores in the OLIF group were (86.3±2.9)%,(69.5±4.1)%,(23.0±3.2)%,and those in the open group were (87.3±3.8)%,(69.8±4.2)%,(23.8±3.6)%,all of which showed significant improvement(P<0.05). Three months after the operation,CRP,PCT,and ESR were significantly lower than those before the operation,and CRP and PCT returned to normal,while ESR was still slightly elevated in some patients. The last follow-up CT showed that continuous trabecular bone formation was observed between the upper and lower endplates of the surgical segments in all patients,and the fusion time was (8.7±4.5) months.
Conclusion The OLIF channel technique combined with posterior internal fixation is a minimally invasive and effective treatment method,which can effectively control infection,relieve pain,and improve the quality of life of patients. Compared with traditional open surgery,it has the advantages of minimally invasive,shorter operation time,and less intraoperative blood loss. |
| KEYWORDS:Lumbar vertebra Internal fixation Intervertebral fusion Infection Oblique lumbar interbody fusion(OLIF) Minimally invasive |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 李生鋆,李俊,张晓锐,宋杰,徐修磊,吕凯,赵兴.斜外侧椎间融合术通道技术在腰椎感染中的应用[J].中国骨伤,2025,25(5):473~481 |
| 英文格式: | LI Sheng-yun,LI Jun,ZHANG Xiao-rui,SONG Jie,XU Xiu-lei,LYU Kai,ZHAO Xing.Application of oblique lateral interbody fusion channel technique in lumbar infection[J].zhongguo gu shang / China J Orthop Trauma ,2025,25(5):473~481 |
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