摘要
目的探讨经皮椎间孔入路内镜下椎间盘切除术(percutaneous endoscopic lumbar discectomy,PELD)联合斜外侧椎间融合术(oblique lateral interbody fusion,OLIF)治疗合并腰椎间盘脱出的腰椎退行性疾病的早期疗效。方法回顾性分析2017年3月至2018年7月采用PELD联合OLIF技术治疗合并腰椎间盘脱出的退行性腰椎滑脱、不稳或腰椎管狭窄症患者11例,男5例,女6例;年龄(61.2±6.8)岁;腰椎滑脱7例,腰椎管狭窄症3例,腰椎不稳1例,均先局麻下行PELD术,再改全麻下行OLIF术。采用视觉模拟评分(visual analogue scale,VAS)、Oswestry功能障碍指数(Oswestry disability in?dex,ODI)评估腰痛、下肢痛及腰椎功能;通过测量手术前后椎管矢状径、椎间隙高度、椎间孔高度、病变节段角和腰椎前凸角等影像学指标评价疗效。结果11例患者PELD手术时间(52.3±13.2)min,术中出血量(10.9±4.7)ml;OLIF手术时间(56.8±18.0)min,术中出血量(65.5±24.6)ml。术后患者均获得随访,随访时间11.2个月。末次随访时腰痛VAS评分为(1.3±0.8)分,下肢痛VAS评分为(1.1±0.5)分,ODI为14.6%±5.3%,以上三个指标均较术前明显改善,差异均有统计学意义(t=10.37,16.49,8.73;均P<0.05)。影像学测量结果显示术前手术节段椎间隙高度为(7.1±1.2)mm,椎间孔高度为(15.3±2.2)mm,椎管矢状径为(6.2±1.3)mm,病变节段角为10.2°±3.5°,腰椎前凸角为16.2°±6.2°;末次随访时手术节段椎间隙高度为(11.5±1.8)mm,椎间孔高度为(19.2±2.6)mm,椎管矢状径为(10.4±2.5)mm,病变节段角为19.3°±7.8°,腰椎前凸角为27.4°±8.3°;以上五个指标手术前后比较,差异均有统计学意义(t=5.83,4.21,6.59,10.32,7.65;均P<0.05)。术后即刻出现屈髋乏力及大腿前外侧麻木各1例,经对症治疗1个月后均缓解;1例术后1个月发生融合器下沉并出现腰痛加重,再次行后路内固定手术后缓解。结论采用PELD联合OLIF手术可以克服单纯OLIF技术间接减压的不足,治疗合并腰椎间盘脱出的退行性腰椎滑脱、不稳或腰椎管狭窄症可以达到椎管直接减压的目的,早期临床疗效满意。
Objective To investigate the preliminary clinical and radiographic outcomes of percutaneous endoscopic lumbar discectomy(PELD)combined with oblique lateral interbody fusion(OLIF)for the degenerative lumbar spondylolisthesis,lumbar spine instability or lumbar spinal stenosis with ruptured disc herniation.Methods Data of 11 patients with degenerative lumbar spondylolisthesis,lumbar spine instability or lumbar spinal stenosis with ruptured disc herniation who had undergone PELD combined with OLIF between March 2017 to July 2018 in our spine surgery center were retrospectively analyzed.There were 5 males and 6 females with an average age of 61.2±6.8 years old.All the patients were diagnosed with degenerative lumbar diseases including lumbar spondylolisthesis(7 cases),lumbar spinal stenosis(3 cases)and segmental instability(1 case).The patients were treated with PELD combined with OLIF.The visual analogue scale(VAS)scores of low back pain and lower limb pain and the Oswestry disability index(ODI)of lumbar function,spinal canal anteroposterior diameter,intervertebral disc height,vertical diameter of intervertebral foramen,segmental angle and the whole lumbar lordotic angle were collected.Results All patients received PELD with local anesthesia before OLIF with general anesthesia.The mean operation time was 52.3±13.2 min and the mean blood loss was 10.9±4.7 ml for PELD.The mean operation time was 56.8±18.0 min and the mean blood loss was 65.5±24.6 ml for OLIF.All patients were followed up for an average of 11.2 months.At the latest follow-up,the mean VAS score for back pain was 1.3±0.8,the mean VAS score for leg pain 1.1±0.5,the mean ODI 14.6%±5.3%,thus all of those were improved significantly compared to those of pre-operation(t=10.37,16.49,8.73;P<0.05).The radiographic results showed the mean pre-operative intervertebral disc height,vertical diameter of intervertebral foramen,spinal canal anteroposterior diameter,segmental angle,and lumbar lordosis angle was 7.1±1.2 mm,15.3±2.2 mm,6.2±1.3 mm,10.2°±3.5°,16.2°±6.2°,and thus all of those were increased significantly to the latest follow-up 11.5±1.8 mm,19.2±2.6 mm,10.4±2.5 mm,19.3°±7.8°,27.4°±8.3°,respectively(t=5.83,4.21,6.59,10.32,7.65;P<0.05).One of the patients had weakness of flexor hip strength and one had a transient paresthesia immediately post-operation.All symptoms were relieved within 1 month.Another one case had cage subsidence and encountered serious back pain after 1 month,and alleviated after percutaneous pedicle screw fixation.Conclusion PELD combined with OLIF can overcome the limitations of OLIF with indirect decompression effects,resulting in successful direct neural decompression without posterior decompressive procedures and providing a satisfactory outcome for the patients with degenerative lumbar diseases with ruptured disc herniation.
作者
楼超
刘飞俊
何登伟
俞伟杨
朱科军
吴忠伟
朱烨
陈剑
Lou Chao;Liu Feijun;He Dengwei;Yu Weiyang;Zhu Kejun;Wu Zhongwei;Zhu Ye;Chen Jian(Department of Orthopaedics,Affiliated Lishui Hospital of Zhejiang University,Lishui 323000,China)
出处
《中华骨科杂志》
CAS
CSCD
北大核心
2020年第8期507-514,共8页
Chinese Journal of Orthopaedics
基金
浙江省自然科学基金(LY17C100002)
浙江省科技厅实验动物科技计划项目(2018C37099)
浙江省医药卫生一般项目(2018KY936)。
关键词
腰椎
椎间盘退行性变
内窥镜检查
脊柱融合术
外科手术
微创性
Lumbar vertebrae
Intervertebral disc degeneration
Endoscopy
Spinal fusion
Surgical procedures
minimally invasive
