摘要
目的探究XLIF微创技术治疗腰椎融合术后邻近节段退变性疾病(ASD)的临床效果。方法回顾性分析2013年8月至2016年10月广州军区广州总医院收治的21例腰椎融合术后ASD患者的临床资料,患者均采用XLIF技术微创通道下减压植骨融合内固定。记录手术时间、术中出血量、围手术期并发症及植骨融合情况,根据术后3个月及末次随访时患者视觉模拟量表(VAS)评分、日本骨科学会(JOA)评分以及Oswestry功能障碍指数(ODI)的变化,评估患者疼痛缓解和功能改善情况。结果平均手术时间78 min(50～100 min),平均术中出血量33 mL(20～50 m L),切口均一期愈合。随访时间12～36个月(平均21.3个月),术后3个月及末次随访时VAS评分、JOA评分、ODI均较术前明显改善(P <0.05);术后6个月X线片、CT检查示内固定物位置良好,植骨均获融合;随访期间无ASD复发病例。结论应用XLIF技术治疗腰椎融合术后ASD可避开原有内固定的干扰,创伤小,恢复快,临床疗效满意。
Objective To evaluate the clinical effects of extreme lateral interbody fusion （XLIF） for treatment of adjacent segment degeneration （ASD） after lumbar spinal fusion. Methods Clinical data of 21 patients with ASD after lumbar spinal fusion, who treated by decompression, interbody fusion and pedicle screw fixation under the working channel of XLIF in Guangzhou General Hospital of Guangzhou Military Command from August 2013 to October 2016, were retrospectively analyzed. Operative time, estimate blood loss,perioperative complications and bony graft fusion were recorded, pain relief and functional improvement of patients were assessed by visual analogue scale （VAS）, Japanese Orthopaedic Association （JOA） scores and Oswestry disability index （ODI） at 3 months after surgery and the latest follow-up. Results The average operative time was 78 min （50 to 100 min）, average estimate blood loss was 33 mL （20 to 50 mL）. Surgical site incisions were healed within normal period in all patients. The average follow-up time was 21.3 months （12 to 36 months）. Postoperative VAS, JOA scores and ODI improved significantly compared with preoperative indicators （P 〈0.05）. X-ray and CT examination at 6 months postoperatively showed that the internal fixators were at good position, and all patients got solid fusion; No ASD reccurrence was found during the follow-up. Conclusion For patients with ASD after lumbar spinal fusion, treatment of XLIF could avoid the interference of former fixations,and has the advantages of less injury, rapid rehabilitation and satisfactory clinical effects.
作者
杨浩志
马向阳
邹小宝
王宾宾
夏虹
吴增晖
YANG Haozhi＊;MA Xiangyang;ZOU Xiaobao;WANG Binbin;XIA Hong;WU Zenghui(Department of Spinal Surgery,Hospital of Orthopaedics,Guangzhou Genenral Hospital of Guangzhou Military Command,Guangzhou,Guangdong 510010,China;Southern Medical University,Guangzhou,Guangdong 510515,China)
出处
《中国骨科临床与基础研究杂志》
2018年第4期197-202,共6页
Chinese Orthopaedic Journal of Clinical and Basic Research
基金
广东省省级科技计划项目(2015B020233013)
关键词
腰椎
脊柱融合术
手术后期间
邻近节段退变
外科手术
微创性
极外侧入路
Lumbar vertebrae
Spinal fusion
Postoperative period
Adjacent segment degeneration
Surgical procedures
minimally invasive
Extreme lateral approach
