摘要
目的 探讨斜外侧腰椎椎间融合(OLIF)联合后路内固定术对伴矢状面失衡的退行性腰椎疾病的治疗效果。方法 2017年9月至2021年8月在北京积水潭医院脊柱外科因腰椎退行性疾病伴矢状面失衡行OLIF联合后路内固定手术的患者40例;其中女27例,男13例;年龄43~81(65.9±5.2)岁。随访时间14~48(28.5±8.3)个月。比较患者术前、术后与末次随访时的脊柱冠状面及矢状面相关参数,包括:椎间隙高度(DH)、椎间孔高度(FH)、腰椎前凸角(LL)、骨盆入射角(PI)、骨盆倾斜角(PT)、骶骨倾斜角(SS)、腰椎侧凸Cobb角、C7铅垂线至骶骨中垂线距离(C7PL-CSVL)、脊柱矢状面垂直轴(SVA)、骨盆腰椎匹配值(PI-LL)。收集患者术前、术后与随访时的主要功能评分,包括腰椎Oswestry功能障碍指数(ODI)、日本骨科协会(JOA)评分、腰部和下肢疼痛视觉模拟(VAS)评分。对术前、术后和末次随访时的影像学和临床指标进行统计学分析。结果 全部患者都一期顺利完成OLIF联合腰后路内固定手术。术后与末次随访时的DH、FH、腰椎侧凸Cobb角、C7PL-CSVL、SVA、LL、PT、SS、PI-LL等指标均明显改善,DH和FH分别由术前(7.8±1.2)mm和(15.6±2.7)mm增加至末次随访的(11.6±2.6)mm和(18.1±2.2)mm;腰椎侧凸Cobb角和C7PL-CSVL分别由术前的(18.1±5.3)°和(27.3±18.3)mm下降至末次随访的(3.4±2.6)°和(10.3±9.1)mm。SVA自(97.3±55.1)mm降为(53.9±41.6)mm。LL由术前的(-8.6±13.2)°增加至末次随访的(-28.0±12.3)°。除PI,各项指标术后及末次随访与术前比较差异有统计学意义(均P<0.05)。末次随访时上述指标与术后比较差异均无统计学意义(P>0.05)。患者术后和末次随访时的ODI、JOA评分、腰部及下肢VAS评分有明显改善,与术前比较差异均有统计学意义(P<0.05)。结论 OLIF联合后路内固定术是一种较为安全和有效的治疗策略,可以有效缓解退行性腰椎疾病伴矢状面失衡患者的症状,同时稳定脊柱、重建矢状面和冠状面平衡,帮助患者提高生活质量。
Objective To investigate the clinical results of OLIF combined with posterior internal fixation in the treatment of degenerative lumbar disease with sagittal imbalance.Methods From September 2017 to August 2021,a retrospective analysis was performed on 40 patients who were treated by oblique lumbar interbody fusion(OLIF) combined with posterior internal fixation for lumbar degenerative disease with sagittal imbalance in Department of Spine Surgery,Beijing Jishuitan Hospital,including 27 females and 13 males,with the age of 43-81(65.9±5.2)years.The follow-up time was 14-48(28.5±8.3)months.Coronal and sagittal parameters of spine were compared among preoperative,postoperative and at the last follow-up,including disc height(DH),foraminal height(FH),lumbar lordosis(LL),pelvic incidence(PI),pelvic tilt(PT),sacral slope(SS),scoliosis cobb angle,C7 plumb line-center sacral vertical line(C7PL-CSVL),sagittal vertical axis(SVA).The functional scores including Oswestry disability index(ODI),Japanese Orthopaedic Association(JOA) scores,and visual analog scale(VAS) of the low back.The lower limbs were collected at preoperation,postoperation and the last follow-up.The radiographic and clinical indicators of preoperation,postoperation,and the last follow-up were analyzed statistically.Results The parameters including DH,FH,scoliosis cobb angle,C7PL-CSVL,SVA,LL,PT,SS and PI-LL were significantly improved after surgery and at the last follow-up compared with those before surgery(P<0.05).DH and FH increased from(7.8±1.2)mm and(15.6±2.7)mm preoperatively to(11.6±2.6)mm and(18.1±2.2)mm at the latest follow-up,respectively.The cobb angle and C7PL-CSVL decreased from(18.1±5.3)° and(27.3±18.3)mm preoperatively to(3.4±2.6)° and(10.3±9.1)mm at the latest follow-up respectively.SVA changed from(97.3±55.1)mm to(53.9±41.6)mm.LL increased from(-8.6±13.2)° preoperatively to(-28.0±12.3)° at the last follow-up.There were no significant differences between all parameters at the last follow-up and those after surgery(P>0.05).ODI,JOA scores,VAS of the low back and the lower limbs were significantly improved after surgery and at the last follow-up which compared with preoperative evaluation(P<0.05).Conclusion OLIF combined with posterior internal fixation is a safe and effective treatment strategy,which can effectively relieve the symptoms of patients with degenerative lumbar disease with sagittal imbalance,while stabilizing the spine,reconstructing the sagittal and coronal balance,also help to improve the quality of life.
作者
梁春红
阎凯
孙宇庆
吴静晔
李观清
Liang Chunhong;Yan Kai;Sun Yuqing;Wu Jingye;Li Guanqing(Department of Spine Surgery,Beijing Jishuitan Hospital,Beijing 100035,China)
出处
《骨科临床与研究杂志》
2023年第4期218-223,共6页
Journal Of Clinical Orthopedics And Research
关键词
脊柱融合术
腰椎
退行性疾病
最小侵入性外科手术
Spinal fusion
Lumbar vertebrae
Degenerative disease
Minimally invasive surgical procedure
作者简介
通信作者:阎凯,E-mail:yankaijst@outlook.com。
