斜外侧腰椎椎间融合术中及术后并发症

目的总结并分析斜外侧腰椎椎间融合术(OLIF)的并发症发生情况及原因。方法回顾性分析2015年6月—2018年6月北京大学第三医院采用OLIF治疗的105例腰椎椎间盘退行性疾病患者临床资料,其中男48例,女57例;年龄29~87岁,平均64岁。统计并分析术中、术后并发症发生情况及其原因。结果105例患者共210个节段融合,手术均顺利完成,随访>6个月。术中出血量为100~300 mL,平均90.2 mL。手术节段L1~533例,L5~S18例,L1~5联合L5~S1同时手术64例。术后6个月所有患者行CT检查,其中99例植骨融合,椎间融合率为94.3%(99/105)。共17例发生并发症,并发症发生率为16.2%(17/105)。融合器沉降5例(4.8%)、肠梗阻3例(2.9%)、血管损伤2例(1.9%)、逆行性射精1例(1.0%)、假关节形成6例(5.7%)。5例融合器沉降均为轻度,未予特殊处理继续随访;3例肠梗阻经对症治疗后症状缓解;2例血管损伤均在术中修复;1例逆行性射精请泌尿外科会诊进行康复治疗后逐渐缓解;6例假关节形成患者均无临床症状,未予特殊处理并继续随访。结论与其他入路腰椎椎间融合术式相比,OLIF具有临床疗效良好及手术相关并发症少的优势,是治疗腰椎退行性疾病较为安全有效的微创手术方式,值得临床推广。

Intraoperative and postoperative complications of oblique lateral lumbar interbody fusion

Objective To summarize the complications of oblique lateral lumbar interbody fusion (OLIF) and analyze its causes. Methods The clinical data of 105 patients treated with OLIF admitted to Peking University Third Hospital from June 2015 to June 2018 were collected. There were 48 males and 57 females who aged 29-87 years old with an average of 64. The occurrence and cause of intraoperative and postoperative complications were analyzed statistically. Results A total of 210 segment-fusion surgeries were successfully performed in 105 patients, and the follow-up time was > 6 months. The intraoperative blood loss was 100-300 mL, with an average of 90.2 mL. The operation segment was L_1-5 in 33 patients, L₅-S₁ in 8, both L_1-5 and L₅-S₁ in 64. Postoperative 6 months CT showed that 99 patients received bone graft fusion, and the intervertebral fusion rate was 94.3%(99/105). Complications occurred in 17 patients, with an incidence of 16.2%(17/105), including cage subsidence in 5 (4.8%), intestinal obstruction in 3 (2.9%), vascular injury in 2 (1.9%), retrograde ejaculation in 1 (1.0%), and pseudoarthrosis in 6 (5.7%). The cages subsidence was mild and no special treatment was given in 5 cases. Symptoms of in testinal obstruction were relieved after symptomatic treatment in 3 cases. The injured vessels were repaired intraoperatively in 2 cases. One case of retrograde ejaculation was gradually relieved after rehabilitation treatment by urological. All the 6 patients with pseudoarthrosis had no clinical symptoms, and no special treatment was given and follow-up was continued. Conclusion Compared with other approaches of lumbar interbody fusion, OLIF is a safe and effective minimally invasive method for the treatment of lumbar degenerative diseases, and is worthy of clinical promotion.