斜外侧腰椎融合技术并发血管损伤的原因分析和预防策略

目的：总结斜外侧腰椎椎间融合术（oblique lateral interboy fusion，OLIF）治疗腰椎退行性疾病并发血管损伤的原因并提出预防措施。方法：回顾性分析2014年10月至2017年5月在5家医院接受OLIF手术联合或不联合后路椎弓根钉棒系统内固定治疗腰椎退行性疾病235例患者的病例资料，男79例，女156例；年龄32~83（61.9±13.5）岁。7例出现血管损伤，其中4例节段血管损伤，1例左髂总动脉损伤，1例左髂总静脉损伤，1例卵巢静脉损伤。结果：失访5例（单纯OLIF 2例，OLIF联合后路椎弓根螺钉固定3例），其余获得随访，时间6~36（15.6±7.5）个月，随访过程中未出现椎弓根螺钉松动或断裂现象。患者腰痛VAS评分由术前的（6.7±2.3）分降至末次随访时的（1.4±0.8）分（t=7.21，P=0.033）；ODI指数由术前的（36.5±7.7）%恢复至末次随访时的（9.4±3.6）%（t=8.11，P=0.025）。结论：斜外侧腰椎融合技术为微创腰椎内固定融合术提供了一种新的方法，但在其广泛应用的同时尚存在并发血管损伤的风险。术前应严格掌握手术适应证，术中要谨慎细致操作，才能有效预防血管损伤的发生。

Analysis on the causes and prevention strategies of the vascular injury caused by the oblique lateral lumbar fusion

Objective: To analyze the causes of vascular injury occurred in oblique lateral interbody fusion for treating lumbar degenerative diseases,and put forward preventive measures.Methods: There were 235 patients analyzed from October 2014 to May 2017 in five hospitals,who were treated with oblique lateral interbody fusion with or without posterior pedicle screw fixation. There were 79 males and 156 females with an average age of (61.9±13.5) years old(ranged from 32 to 83 years). There were 7 cases of vascular injury,including 4 cases of segmental vessel injury,1 case of left common iliac artery injury,1 case of left common iliac vein injury and 1 case of ovarian vein injury.Results: The follow-up time ranged from 6 to 36 months,averagely(15.6±7.5) months. There was no pedicle screw loosen or fracture. The low back pain VAS decreased from preoperative 6.7±2.3 to 1.4±0.8 at the latest follow-up,which was statistically difference(t=7.21,P=0.033). The ODI decreased from preoperative (36.5±7.7)% to (9.4±3.6)% at the latest follow-up,which was statistically difference(t=8.11,P=0.025).Conclusion: Oblique lateral interbody fusion technique provides a new method for minimally invasive fusion of lumbar internal fixation. However,it has a risk of vascular injury. In order to effectively prevent the occurrence of vascular injury,the operative indications and careful and meticulous operation should be strictly grasped.