极外侧椎间融合联合经皮螺钉固定术治疗腰椎退变性疾病的早期疗效及安全性

摘要

目的:分析极外侧椎间融合(extreme lateral interbody fusion,XLIF)联合经皮椎弓根螺钉固定术治疗腰椎退变性疾病的早期疗效及安全性.方法:2013年1月至2014年6月采用极外侧椎间融合术联合经皮椎弓根螺钉固定术治疗腰椎退变性疾病13例,其中腰椎不稳症8例,轻中度腰椎滑脱症5例;男5例,女8例;年龄56~73岁,平均62.1岁;均为单节段融合.记录手术时间、术中出血量和围手术期并发症;术前及末次随访时采用疼痛视觉模拟评分(visual analogue scale,VAS)和功能障碍指数(Oswestry Disability Index,ODI)进行疗效评价;通过腰椎X线片及CT扫描评价椎间融合情况及手术前后椎间孔面积变化.结果:13例患者平均手术时间(62.8±5.2)min,平均失血量(82.5±22.6)ml.术后1例大腿内侧麻木,1例屈髋肌力下降,均在2周内恢复正常.所有患者获得随访,时间12~19个月,平均15.6个月.末次随访时腰痛VAS评分由术前的(7.31±0.75)分降低至(2.31±0.75)分(P<0.05),ODI由术前的(42.58±1.55)%降低至(12.55±0.84)%(P<0.05);影像学证实末次随访时8例患者完全融合,5例患者部分融合;椎间孔面积由术前的(94.86±2.44)mm2提高至术后的(150.70±7.02)mm2(P<0.05).结论:极外侧椎体间融合联合经皮椎弓根螺钉固定术治疗腰椎退变性疾病早期疗效好,是理想的治疗方法.%Objective:To evaluate the early efficacy and safety of extreme lateral interbody fusion (XLIF) combined with percutaneous pedicle screw fixation for lumbar degenerative disease. Methods:From January 2013 to June 2014,13 patients with degenerative lumbar disease were treated with XLIF combined with percutaneous pedicle screw fixation ,including 8 cases of lumbar instability,5 cases of mild to moderate lumbar spondylolisthesis;there were 5 males and 8 females,aged from 56 to 73 years with an average of 62.1 years. All patients were single segment fusion. Operation time ,perioperative bleeding and pe-rioperative complications were recorded. Visual analogue scale (VAS) and Oswestry Disability Index (ODI) were used to e-valuate the clinical efficacy. Interbody fusion rate was observed and the intervertebral foramen area changes were compared preoperation and postoperation by X rays and CT scanning. Results:The mean operation time and perioperative bleeding in the patients respectively was(62.8±5.2) min and(82.5±22.6) ml. One case occurred in the numbness of femoribus internus and 1 case occurred in the muscle weakness of hip flexion after operation ,both of them recovered within 2 weeks. All the patients were followed up from 12 to 19 months with an average of 15.6 months. VAS was decreased from preoperative 7.31 ±0.75 to 2.31±0.75 at final follow up(P<0.05);ODI was decreased from preoperative (42.58±1.55)%to (12.55±0.84)%at final follow up (P<0.05). At final follow up,CT scanning confirmed 8 cases completely fused and 5 cases partly fused;the intervertebral foramen area was increased from preoperative (94.86±2.44)mm2 to (150.70±7.02)mm2(P<0.05). Conclusion:Extreme lateral interbody fusion combined with percutaneous pedicle screw fixation is an ideal method and can obtain early good clinical ef-fects in treating lumbar degenerative disease.