OLIF治疗腰椎融合术后邻近节段退变性疾病的疗效观察

目的探讨斜外侧入路稚间融合术(OLIF)治疗腰椎融合术后邻近节段退变性疾病(ASD)的疗效。方法回顾性分析2017年6月至2019年12月18例行OLIF术治疗ASD患者的临床资料。记录手术时间、术中出血量、并发症、术后住院天数等。临床疗效评价采用视觉模拟量表(VAS)评分、日本骨科学会(JOA)评分和功能障碍指数(ODI)。摄腰椎正侧位X片,测量手术前后椎间隙高度(IDH)、椎间孔高度(IFH)和椎间孔面积(IFA)等影像学参数。摄腰椎CT三维重建评估植骨融合情况。结果平均手术时间(71±15)min(50~95 min),手术出血量(65±28)ml(20~200 ml),术后平均住院(7±2)d(4~9d)。随访时间12~36个月(平均18个月),术后末次随访的VAS评分、JOA评分和ODI指数比术前明显改善(P<0.05),影像学测量结果显示手术节段IDH、IFH、IFA由术前(5.5±0.6)mm、(15.3±1.4)mm、(135.3±6.5)mm分别增至术后(10.4±0.5)mm、(20.1±2.2)mm、(200.6±12.5)mm。术后2例患者出现术侧大腿前侧疼痛、屈髖无力,对症处理后症状消失。1例患者出现融合器下沉,但未出现临床症状,末次随访时椎间植骨已融合。所有患者术后1年植骨均获融合,未发现ASD复发。结论OLIP是治疗腰椎融合术后ASD的安全有效术式,获得满意的近期临床疗效。

The effect of olif on adjacent segment degenerative disease after lumbar fusion

Objective To evaluate the clinical value of oblique lateral interbody fusion(OLIF)for the treatment of adjaccnt segment disease.(ASD).Methods Clinical data of 18 patients with ASD after lumbar spinal fusion who underwent OLIF in our hospital from June 2017 to December 2019 were selected.The operation time,intraoperative blood loss,complications and length of stay were recorded.Clinical outcomes were evaluated with visual analogue(VAS)score,Japanese Orthopaedic Association(JOA)and Oswestry disability index(ODI).The standard anteroposterior and lateral roentgenographs were taken to measure intervertebral disc height(IDH),intervertebral foramen height(IFH)and intervertebral foramen area(IFA).The fusion was evaluated by Lumbar CT three-dimensional reconstruction.Results The operation time was 71 min(50~95 mim),the intraoperative blood loss was 65 ml(20~200 ml)and the length ofstay was7d(4~9d).The fllow-up time was 18 months(12~36 months),postoperative VAS,JOA and ODI were improved significantly compared with preoperative indicators at the last follow-up.Imaging measurements showed IDH,IFH and IFA were increased from(5.5±0.6)mm,(15.3±1.4)mm and(135.3+6.5)mm2 to(10.4±0.5)mm,(20.1±2.2)mm and(200.6±12.5)mm2.Two patients occured ipsilateral anterior thigh pain and hip muscle weakness after operation,both returned to normal after symptomatic treatment.Cage subsidence was found in one patient which not lead to related clinical symptoms,and fusion was completed at the last follow-up.All patients got solid fuson and no ASD recurrence was found during the follow-up.Conclusion OLIF as a novel spinal minimally invasive technique showed excellent shot-term clinical outcomes n treating ASD.