摘要
[目的]观察OLIF技术联合后路Wiltse入路内固定治疗单节段腰椎结核的临床效果。[方法] 2015年3月~2018年3月本院手术治疗40例单节段腰椎结核患者,根据手术方法不同将其分为OLIF技术联合后路Wiltse入路内固定手术组(微创组)和传统前路病灶清除联合后路内固定手术组(传统组)。记录两组患者的围手术期资料,评估患者腰部疼痛、神经功能恢复、植骨融合及病灶治愈情况。[结果]两组在手术时间的差异无统计学意义(P>0.05),而微创组腹部切口长度、术中出血量、术后引流量、住院时间均显著优于传统组(P<0.05)。两组患者随访15~48个月,平均(34.42±7.61)个月。两组患者术后腰痛VAS评分均显著低于术前(P<0.05);微创组在术后各时间段的腰痛VAS评分均显著低于传统组(P<0.05)。两组中所有术前有神经功能损害的患者,末次随访时神经功能完全恢复正常。两组患者术后ESR和CRP均较术前显著下降(P<0.05),但相同时间点两组间差异无统计学意义(P>0.05)。两组术后前凸Cobb角均较术前显著增加(P<0.05),但相同时间点两组间差异无统计学意义(P>0.05)。至末次随访时,两组所有患者均达到病灶愈合、骨性融合。[结论] OLIF技术联合后路Wiltse入路内固定术治疗单节段腰椎结核与传统前后路手术相比,病灶治愈效果相当,但其创伤小,术后并发症少,患者康复快。
[Objective] To investigate the clinical efficacy of oblique lumbar interbody fusion(OLIF) combined posterior instrumentation through Wiltse approach for single-segmental lumbar tuberculosis. [Methods] From March 2015 to March 2018,40 patients with single-segmental lumbar tuberculosis underwent surgical treatment in our hospital. Of them, 20 patients who termed as the minimal invasive(MI) group received posterior pedicle screw fixation through the Wiltse approach in the prone position, and then anterior debridement and fusion by OLIF technique in the lateral position, while the remaining 20 patients who named as the traditional group underwent the routine posterior instrumentation through midline approach in the prone position,subsequently routine anterior debridement and bone grafting in the lateral position. The perioperative data were compared between the two groups. In addition, the lumbar pain, nerve function recovery, bony fusion and focal lesion healing were assessed.[Results] All patients in both groups had surgical procedures performed smoothly without serious intraoperative complications.Although no statistically significant difference in operative time was noticed between the two groups(P>0.05), the MI group proved significantly superior to the traditional group regarding length of abdominal incision, intraoperative blood loss, postoperative drainage, and length of hospitalization(P<0.05). The follow up period lasted for 15~48 months, with a mean of(34.42±7.61) months. The VAS scores of low back pain postoperatively in both groups significantly decreased compared with those before surgery(P<0.05), which in the MI group were significantly lower than those in the traditional group at all time points postoperatively(P<0.05). To the latest follow up, all patients who had neurological deficiencies before operation achieved complete recovery of neurological function in both groups. The ESR and CRP in both groups significantly decreased postoperatively compared with those before operation(P<0.05), without statistically significant differences between the two groups at any matching time point postoperatively(P>0.05). In addition,the lumbar kyphotic Cobb’s angles significantly increased postoperatively compared with those before operation(P<0.05), without statistically significant differences between the two groups at any matching time point postoperatively. To the latest follow up, all the patients achieved bony fusion and lesion healing in both groups. [Conclusion] The OLIF combined posterior instrumentation through Wiltse approach has benefits of minimizing iatrogenic trauma, reducing postoperative complications and enhancing recovery over the traditional procedures for single-segmental lumbar tuberculosis, although both surgical procedures achieve similar clinical outcomes.
作者
张佳林
乔永东
袁海峰
王自立
施建党
原文琦
ZHANG Jia-lin;QIAO Yong-dong;YUANHai-feng;WANG Zi-li;SHI Jian-dang;YUAN Wenqi(Department o f Spinal Surgery,General Hospital,Ningxia Medical University,Yinchuan 750004,China)
出处
《中国矫形外科杂志》
CAS
CSCD
北大核心
2019年第21期1954-1959,共6页
Orthopedic Journal of China
关键词
单节段腰椎结核
OLIF
Wiltes入路
single-segment lumbar tuberculosis
oblique lumbar interbody fusion(OLIF)
Wiltse approach
