【摘要】 目的探讨多节段斜外侧腰椎椎间融合术(oblique lumbar interbody fusion,OLIF)治疗退行性腰椎侧凸的短期临床疗效。方法回顾性研究2018年7月至2020年2月因退行性腰椎侧凸行多节段OLIF治疗的26例资料,其中男7例,女19例;年龄47～84岁,平均(63.17±18.31)岁。Lenke Silva分型Ⅲ型15例、Ⅳ型8例、Ⅴ型2例、Ⅵ型1例。收集术前及末次随访影像学资料,测量冠状面侧凸Cobb’s角、骨盆腰椎匹配值(pelvic incidence-lumbar lordosis,PI-LL)、矢状面平衡(sagittal aertical axis,SVA)、骨盆倾斜角(pelvic tilt,PT)参数;临床疗效评价采用疼痛视觉模拟评分(visual analogue scale,VAS)和 Oswestry 功能障碍指数(oswestry dability index,ODI),计算植骨融合率。结果所有患者均顺利完成OLIF联合内固定手术,一期行单纯OLIF,三节段18例、四节段8例;间隔5～10天,平均(7.2±1.7)天,二期行椎弓根钉内固定术,后路经皮椎弓根螺钉内固定融合术3例,经Wiltse入路行腰椎椎弓根内固定术12例,切开植入椎弓根内固定融合术11例。住院时间平均(13.7±2.1)天。随访时间8～21个月,平均(15.9±3.4)个月。冠状面术前Cobb’s角(20.3±3.0)°,末次随访(5.4±1.4)°;术前PI-LL(30.7±8.8)°,末次随访(13.5±1.2)°;SVA 术前(69.9±5.7)mm,末次随访(28.6±4.5)mm;术前PT(23.3±3.2)°,末次随访(12.1±6.1)°;腰痛VAS术前、术后1个月、3个月及末次随访分别为(6.3±1.0)分、(3.2±1.4)分、(1.8±0.6)分、(1.1±0.9)分;下肢痛VAS术前、术后1个月、3个月及末次随访分别为(5.2±0.8)分、(2.8±2.3)分、(1.3±0.2)分、(1.0±0.7)分;ODI术前、术后1个月、3个月及末次随访分别为32.7±0.4、19.1±0.9、16.7±2.7、14.7±0.3。OLIF联合内固定手术治疗腰椎侧凸患者术后症状较术前明显改善,差异有统计学意义(P < 0.05)。根据Suk标准,所有患者椎间融合达到100%。术中1例出现节段动脉损伤,1例出现髂总静脉损伤;术后1例出现终板损伤;5例出现屈髋屈膝乏力,4例在术后 2周内恢复,1例在术后4周随访期内消失。2例出现大腿前外侧麻木,均在术后3个月恢复。结论 OLIF 治疗多节段退行性腰椎侧凸围术期并发症较轻,脊柱畸形改善和临床疗效良好,可以显著缓解患者的疼痛,改善患者的功能,是一种微创、有效、风险小的手术方式。更多还原

【Abstract】 Objective To explore the short-term clinical effect of multi-segment oblique lateral lumbar interbody fusion (OLIF) in the treatment of degenerative lumbar scoliosis.Methods A retrospective study was conducted on the data of 26 patients after multi-level OLIF for degenerative lumbar scoliosis from July 2018 to February 2020.There were 7 males and 19 females,with an average age of (63.17±18.31) years (range:47-84 years).Lenke-Silva classifications:type Ⅲ in 15 cases;type Ⅳ in 8 cases;type Ⅴ in 2 cases;type Ⅵ in 1 case.Cobb’s angle of the coronal scoliosis,pelvic incidence-lumbar lordosis (PI-LL),sagittal vertical axis (SVA),pelvic tilt (PT),visual analogue scale (VAS) and Oswestry disability index (ODI) preoperatively and at the final follow-up were collected.Bone graft fusion rate was calculated.Results OLIF combined with internal fixation was successfully completed in all patients.First-stage OLIF was performed in 3 segments of 18 cases and 4 segments of 8 cases.The average interval was (7.2±1.7) days (range:5-10 days).Second-stage posterior percutaneous pedicle screw internal fixation and fusion were applied in 3 cases,Wiltse approach in 12 cases,and traditional pedicle screw internal fixation and fusion in 11 cases.The average hospital stay was (13.7±2.1) days.The mean follow-up was(15.9±3.4) months (range:8-21 months).The average coronal Cobb’s angle,PI-LL,SVA and PT preoperatively and at the final follow-up:(20.3±3.0) °,(5.4±1.4) °;(30.7±8.8) °,(13.5±1.2) °;(69.9±5.7) mm,(28.6±4.5) mm;(23.3±3.2) °,(12.1±6.1) °.The average lumbar and lower limb VAS preoperatively,1 month and3 months postoperatively,and at the final follow-up:(6.3±1.0),(3.2±1.4),(1.8±0.6),(1.1±0.9);(5.2±0.8),(2.8±2.3),(1.3±0.2),(1.0±0.7).The average ODI preoperatively,1 month and 3 months postoperatively,and at the final follow-up:(32.7±0.4),(19.1±0.9),(16.7±2.7),(14.7±0.3).OLIF combined with internal fixation achieved statistically significant improvement in the treatment of lumbar scoliosis (P < 0.05).According to the Suk standard,all patients achieved 100% intervertebral fusion.Segmental artery injury occurred in 1 case and iliac vein injury in 1 case intraoperatively;1 case of endplate injury and 5 cases of hip and knee flexion fatigue were noted postoperatively,while 4 cases recovered 2 weeks after surgery and 1 case recovered 4 weeks after surgery;2 cases of anterior and lateral thigh numbness recovered 3 months after surgery.Conclusions OLIF is a minimally invasive,effective and low-risk approach in the treatment of multi-segment degenerative lumbar scoliosis.It is recommended by good correction of spinal deformity,less perioperative complications,relieved pain and improved functions.更多还原