斜外侧椎间融合术联合小切口Wiltse入路椎弓根螺钉固定治疗腰椎滑脱症早期疗效

目的探讨斜外侧椎间融合术(oblique lateral interbody fusion,OLIF)联合小切口Wiltse入路椎弓根螺钉固定治疗腰椎滑脱症的早期疗效。方法2016年1月-12月,采用OLIF联合小切口Wiltse入路椎弓根螺钉固定治疗21例腰椎滑脱症患者。男9例,女12例;年龄57~73岁,平均64.5岁。病程24~60个月,平均34.6个月。患者均为L4椎体滑脱(Ⅰ度15例、Ⅱ度6例);合并椎弓峡部裂1例、椎管狭窄20例。术前及末次随访时采用日本骨科协会(JOA)评分评价临床疗效;术前及术后2 d摄腰椎正侧位X线片及CT,测量椎管矢状径和椎管横截面积,并计算椎间高度和椎体滑脱程度;术后6个月根据CT评价椎间融合情况。结果手术时间120~180 min,平均155 min;术中出血量100~340 mL,平均225.5 mL。1例患者术中下终板轻度损伤,1例术后出现大腿麻木、屈髋无力症状,l例出现腰交感神经干损伤症状。21例均获随访,随访时间12~18个月,平均14.3个月。术后患者下腰痛、腿痛、下肢麻木症状较术前明显改善,无椎间融合器脱出、螺钉断裂、终板塌陷等并发症发生。术后2 d测量椎间高度、椎体滑脱程度、椎管矢状径和椎管横截面积均较术前显著改善(P<0.05)。术后6个月CT检查示1例患者椎间融合欠佳(Ⅲ级),余20例椎间融合良好(Ⅰ、Ⅱ级),椎间融合率为95.2%。末次随访时腰椎JOA评分较术前显著增加,差异有统计学意义(t=24.980,P=0.000)。结论OLIF联合小切口Wiltse入路椎弓根螺钉固定治疗腰椎滑脱症,具有创伤小、并发症少等微创特点以及较高的椎间融合率,是一种安全、有效的治疗术式。

Early effectiveness of oblique lateral interbody fusion combined with pedicle screw fixation via small incision Wiltse approach for lumbar spondylolisthesis

Objective To investigate the early effctiveness of oblique lateral interbody fusion(OLIF)combined with pedicle screw fixation via small incision Wiltse approach for the treatment of lumbar spondylolisthesis.Methods Between January 2016 and December 2016,21 patients with lumbar spondylolisthesis were treated with OLIF and pedicle screw fixation via small incision Wiltse approach.There were 9 males and 12 females,aged 57-73 years,with an average age of 64.5 years.The disease duration was 24-60 months,with an average of 34.6 months.All cases were spondylolisthesis at L4(15 cases of degreeⅠ,6 cases of degreeⅡ);1 case had vertebral arch isthmus,and 20 cases had spinal stenosis.Japanese Orthopaedic Association(JOA)scoring system was used to evaluate the effectiveness before operation and at last follow-up.Before operation and at 2 days after operation,anteroposterior and lateral X-ray films and CT were taken to measure the sagittal diameter and cross-sectional area of the spinal canal,and calculate the intervertebral height and degree of spondylolisthesis.At 6 months after operation,the intervertebral fusion was evaluated by CT.Results The operation time was 120-180 minutes,with an average of 155 minutes;the intraoperative blood loss was 100-340 mL,with an average of 225.5 mL.One patient had slight injury of lower endplate,1 patient had numbness of thigh and weakness of hip flexion after operation,1 patient had sympathetic nerve trunk injury.All the cases were followed up 12-18 months,with an average of 14.3 months.The symptoms of low back pain,leg pain,and numbness of lower limbs significantly relieved after operation,and there was no complication such as protrusion of fusion cage,screw breakage,and endplate collapse.At 2 days after operation,the intervertebral height,degree of spondylolisthesis,sagittal diameter of spinal canal,and cross-sectional area of spinal canal significantly improved compared with preoperative ones(P<0.05).At 6 months after operation,CT showed that 1 patient had poor interbody fusion(gradeⅢ),the other 20 patients had good interbody fusion(gradeⅠandⅡ),and the interbody fusion rate was 95.2%.At last follow-up,JOA score of lumbar spine significantly increased compared with that before operation(t=24.980,P=0.000).Conclusion OLIF combined with pedicle screw fixation via small incision Wiltse approach for the lumbar spondylolisthesis has minimally invasive features,such as less trauma,fewer complications,and higher intervertebral fusion rate.It is a safe and effective method.