摘要：
目的 探讨斜外侧腰椎椎间融合术(oblique lateral interboy fusion,OLIF)治疗腰椎退行性疾病的早期并发症.方法 回顾性分析2014年10月至2017年2月83例接受OLIF手术联合或不联合后路椎弓根钉-棒系统内固定治疗腰椎退行性疾病患者的病历资料,男29例,女54例;年龄32～83岁,平均(60.8±13.7)岁.椎间盘源性腰痛17例,腰椎轻度滑脱23例,腰椎管狭窄症25例,退行性腰椎侧后凸畸形18例.手术节段L1,25例、L2,313例、L3,438例、L4,569例,平均手术节段1.5节.记录手术时间、术中出血量、术中及术后并发症、术后住院时间等.临床疗效评价采用视觉模拟疼痛评分(visual analogue scale,VAS)和Oswestry功能障碍指数(Oswestry disability index,ODI).摄腰椎正、侧位X线,CT扫描并评估内植物及融合器沉降情况.结果 83例患者中51例联合后路椎弓根钉-棒系统内固定,手术时间43～460 min,平均(132±68)min,每个节段(不含内固定操作)手术时间平均(43±12) min.术中出血量30～640 ml,平均(125±74)ml,每个节段OLIF手术中出血量平均(27±13)ml.术后住院时间3～15 d,平均(5.6±3.2)d.所有患者术后腰痛VAS评分、腿痛VAS评分及ODI均明显降低.总体并发症发生率为22.9％(19/83),术中并发症为5例(6.0％),包括4例(4.8％)入路无关的融合器沉降,1例(1.2％)入路相关的节段动脉损伤;术后并发症为14例(16.9％),包括6例(7.2％)术侧腰大肌无力,2例(2.4％)术侧大腿前外侧疼痛,1例(1.2％)术侧大腿外侧麻木,1例(1.2％)对侧屈髋疼痛,2例(2.4％)术侧交感链损伤症状,2例(2.4％)取髂骨区疼痛.所有并发症在随访期间均得到不同程度地缓解或消失.结论 OLIF技术作为一种新的脊柱微创技术,为腰椎退行性病变提供了一项安全、有效的治疗方式,且能明显降低入路相关并发症的发生率.%Objective To evaluate the early clinical outcomes and complications of oblique lateral interbody fusion (OLIF) in the treatment of degenerative lumbar diseases.Methods All of 83 patients,29 males and 54 females with ages from 32 to 83 (average 60.8± 13.7 y),underwent OLIF with or without posterior pedicle screw-rod instrumentations from October 2014 to February 2017.The index diagnosis was discogenic back pain in 17 cases,spondylolisthesis in 23,lumbar spinal canal stenosis in 25,and degenerative lumbar spinal kyphoscoliosis in 18 cases.The distribution of operative level was 5 at L1,2,13 at L2,3,38 at L3,4,and 69 at L4,5.The mean number of fusion level for each case was 1.5 segments.The operative duration,blood loss during operation,intra-operative and post-operative complications,the length of post-operative hospital stay were recorded.Clinical outcomes were evaluated using visual analogue scale (VAS) and Oswestry disability index (ODI).All patients were followed up for at least 3 months.Lumbar X-ray and CT scans were taken and the clinical outcomes were re-assessed during follow-up.Results Fifty-one in the 83 patients underwent supplementary posterior pedicle screw-rod instrumentation with OLIF procedures.The operation lasted for 43-295 min,with a mean duration of (153 ± 72) min.Mean operation time for each OLIF segment was 43± 12 min.Blood loss during the operation was 30-800 ml,with a mean of 125±74 ml.Mean blood loss for each OLIF segment was 27±13 min.Average length of stay was 5.6 ± 3.2 d,ranging from 3-15 d.The VAS for back pain and leg pain and ODI scores were decreased apparently for each patient.The total incidence of complications was 22.9％ (19/83),including 6.0％ (5/83) of intra-operative complications (4 cases of cage subsidence,1 case of segmental artery injury) and 16.9％ (14/83) of post-operative ones.The latter consisted of ipsilateral hip flexor weakness in 6,ipsilateral anterolateral thigh pain in 2,ipsilateral lateral thigh numbness in 1,contralateral pain in flexion of hip in 1,ipsilateral sympathetic chain injury in 2,and pain in area of iliac bone donor site in 2.All symptoms were released or disappeared during follow-up.Conclusion OLIF as a novel minimally invasive technique can act as a safe and effective treatment for degenerative lumbar diseases,which can also reduce approach-related complications.
