| 刘权祥,程 维,郭天明,熊 靖,李 霖.后路经皮椎弓根螺钉撑开复位固定联合斜外侧入路椎间融合术治疗腰椎滑脱症的疗效分析[J].中国脊柱脊髓杂志,2022,(4):319-326. |
| 后路经皮椎弓根螺钉撑开复位固定联合斜外侧入路椎间融合术治疗腰椎滑脱症的疗效分析 |
| 中文关键词: 腰椎滑脱症 斜外侧椎间融合术 经皮椎弓根螺钉 微创 |
| 中文摘要: |
| 【摘要】 目的：探讨后路经皮椎弓根螺钉撑开复位固定联合斜外侧入路椎间融合术（oblique lateral interbody fusion，OLIF）治疗腰椎滑脱症的疗效。方法：回顾性分析2018年9月~2021年1月我院采用后路经皮椎弓根螺钉撑开复位固定技术联合OLIF治疗的30例腰椎滑脱症患者，其中男9例、女21例；年龄44～76岁（61.5±7.4岁），随访时间13.3±5.1个月（8~26个月）。记录手术时间、术中出血量、术后并发症，比较术前、术后1周、术后3、6、12个月和末次随访时的腰腿痛VAS评分、Oswestry功能障碍指数（Oswestry disability index，ODI）及健康调查简表（the MOS 36-item short-form health survey，SF-36）评分；于术前、术后1周、术后6个月及末次随访时在X线片上测量手术节段椎间孔高度（foramen height，FH）、椎间隙高度（disc height，DH）、滑移百分比（slipping percentage，SP）、节段前凸角（segmental lordosis，SL）、腰椎前凸角（lumbar lordosis，LL），通过MRI测量硬膜囊轴向直径及横截面积，通过CT评估椎间融合情况。结果：所有患者手术顺利，手术时间105．0±20．8min，术中出血量55．8±20．6ml。术中节段血管损伤出血1例，应用双极电凝及明胶海绵压迫止血成功。术后出现短暂的腰大肌无力3例；单侧大腿外侧疼痛、感觉减退4例，保守治疗，术后1个月随访时症状均已完全消失。术中未出现终板、腹膜及输尿管损伤情况，术后无下肢运动障碍、无感染及融合器下沉移位等并发症。术后1周、术后3、6、12个月及末次随访时腰腿痛VAS评分、ODI及SF-36评分均较术前显著性改善，差异有统计学意义（P<0．05），术后各时间点随访比较差异均无统计学意义（P>0．05）。术后1周、6个月及末次随访时手术节段FH、DH、SP、SL、LL、硬膜囊轴向直径及横截面积均较术前显著性改善，差异有统计学意义（P<0．05），术后各时间点随访比较差异均无统计学意义（P>0．05）。术后6个月至末次随访时所有患者椎间均骨融合。结论：后路经皮椎弓根螺钉撑开复位固定联合OLIF治疗腰椎滑脱症的临床疗效满意，椎体滑脱复位确切，有效矫正腰椎前凸及节段前凸，椎间融合率高，椎管间接减压效果满意，是治疗腰椎滑脱症安全、有效的术式。 |
Efficacy analysis of posterior percutaneous pedicle screw distraction reduction and fixation combined with oblique lateral interbody fusion in the treatment of lumbar spondylolisthesis |
| 英文关键词:Lumbar spondylolisthesis Oblique lateral interbody fusion Percutaneous pedicle screw Minimally invasive |
| 英文摘要: |
| 【Abstract】 Objectives: To explore the clinical effect of posterior percutaneous pedicle screw distraction reduction and fixation combined with oblique lateral interbody fusion(OLIF) in the treatment of lumbar spondylolisthesis. Methods: 30 patients with lumbar spondylolisthesis treated with posterior percutaneous pedicle screw distraction reduction and fixation combined with OLIF in our hospital from September 2018 to January 2021 were analyzed retrospectively. There were 9 males and 21 females, averaged 61.5±7.4 years old(44-76 years) and followed up for 13.3±5.1 months(8-26 months). The operative time, intraoperative blood loss, and postoperative complications were recorded, and the VAS scores of low back and leg pain, Oswestry disability index(ODI), and the scores of 36-item short-form health survey(SF-36) before operation, 1 week, 3, 6, 12 months after operation, and at the final follow-up were compared to evaluate the clinical efficacy. The foraminal height(FH), disc height(DH), slipping percentage(SP), segmental lordosis(SL), and lumbar lordosis(LL) of the operational segment were measured on X-ray images before operation, at 1 week and 6 months after operation, and at the final follow-up. The axial diameter and cross-sectional area of dural sac were measured on MRI images, and intervertebral fusion was evaluated by CT scan. Results: The average operative time was 105．0±20．8min and average intraoperative blood loss was 55．8±20．6ml. 1 case occurred segmental vascular injury and bleeding during operation, and 4 cases had lateral thigh pain and hypoesthesia after operation, whose symptoms completely disappeared at 1 month after operation. No endplate injury, peritoneal injury or ureteral injury occurred during operation, nor were there complications such as lower limb dyskinesia, infection or cage subsidence or displacement. The VAS scores, ODI, and SF-36 scores at 1 week, 3, 6, and 12 months, and at the last follow-up were improved greatly than those before operation with statistically significant differences(P<0．05), while there were no significant differences between those at each postoperative follow-up time points(P>0．05). The FH, DH, SP, SL, LL, axial diameter and cross-sectional area of dural sac at 1 week and 6 months after operation and the final follow-up were improved significantly comparing with those before operation with statistical differences(P<0．05), while no statistical differences were there between those at each postoperative time points(P>0．05). The interbody fusion rate was 100% in all cases between 6 months and the last follow-up. Conclusions: The clinical effect of posterior percutaneous pedicle screw distraction reduction and fixation combined with OLIF in the treatment of lumbar spondylolisthesis is satisfactory, which can achieve accurate reduction of lumbar spondylolisthesis, correct the lumbar lordosis and segmental lordosis effectively. With a high rate of interbody fusion and satisfactory indirect decompression of spinal canal, it is a safe and effective operation for the treatment of lumbar spondylolisthesis. |
| 投稿时间：2021-09-01 修订日期：2022-03-18 |
| DOI： |
| 基金项目:吉林省卫生健康技术创新项目（NO.2019J047）；吉林省教育厅“十三五”科学技术项目（NO.JJKH20180364KJ）；吉林省教育厅科学技术研究项目（JJKH20220074KJ） |
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