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小切口前外侧入路腰椎椎间融合术在腰椎翻修手术中的应用

The mini-open anterolateral lumbar interbody fusion (MO-ALLIF)with self-anchored stand-alone cage in lumbar revision surgery

摘要:

目的 评价小切口前外侧入路腰椎椎间融合术(mini-open anterolateral lumbar interbody fusion,MO-ALLIF)应用于腰椎翻修手术的疗效和安全性.方法 回顾性分析2013年4月至2016年4月在单中心17例应用MO-ALLIF进行腰椎翻修手术患者的病历资料,男7例,女10例;年龄41~65岁,平均(53.9±7.2)岁.L4.511例,L3,44例,L5S15例;单节段14例,双节段3例.翻修原因:内植入物(cage)移位2例,假关节形成3例,邻近节段椎间盘突出再发6例,同节段椎间盘突出复发6例.临床表现主要为腰痛和腿痛.统计手术时间、术中出血量和围手术期并发症,临床疗效评估采用Oswestry功能障碍指数(Oswestry disability index,ODI)、疼痛视觉模拟评分(visual analogue scale,VAS),影像学参数评估采用融合率、腰椎前凸角、手术节段椎间隙高度、椎间孔高度和沉降情况.结果 手术时间为56~114 min,平均(74.0±15.5) min;术中出血量为83~180 ml,平均(122.4±28.8) ml.随访时间12~48个月,平均(22.7±8.6)个月.术后各随访时间点的腰痛VAS评分、腿痛VAS评分及ODI均较术前明显改善.术后各随访时间点的腰椎前凸角、手术节段椎间隙高度和椎间孔高度均较术前有明显改善.末次随访时所有患者均获得牢固融合,无融合器移位.术中1例患者发生腹膜撕裂,经修补后无不适.结论 MO-ALLIF具有手术创伤小、入路相关并发症少等优点,术后能恢复腰椎前凸角、椎间隙高度和椎间孔高度,近期临床效果满意,可安全、有效地应用于部分患者的腰椎翻修手术,但远期疗效有待于进一步随访观察.

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abstracts:

Objective To evaluate the safety and efficacy of the mini-open anterolateral lumbar interbody fusion (MO-ALLIF) in lumbar revision surgery.Methods Seventeen patients,seven male and ten female,who underwent revision lumbar surgeries using MO-ALLIF with self-anchored stand-alone polyetheretherketone (PEEK) cage in a single center between April 2013 and April 2016 were studied retrospectively.There were 14 of sing-level cases and 3 of double-level cases.Among them,11 cases were L4.5,4 cases were L3,4,5 cases were L5S1.There were 2 cases of cage migration,3 cases of pseudarthrosis,6 cases of recurrent lumbar disc herniation of the same level,and 6 cases of lumbar disc herniation on the adjacent level.The average age was 53.9±7.2 years (range,41-65 years).The clinical manifestation was low back pain and/or leg pain.The operation time,blood loss,and perioperative complications were evaluated.Oswestry disability index (ODI) and visual analog scale (VAS) score of leg and back pain were analyzed preoperatively and at each time point of follow-up postoperatively.Radiological evaluation including fusion,global lumbar lordosis,disc height on the operation level,foraminal height on the operation level,and subsidence were assessed.Results The average follow-up time was 22.7±8.6 months(12-48 months).Among the seventeen patients that participated in this study with a total of 20 segments,only one patient suffered from peritoneal rupture,but no symptom was observed after suturing.No other approach-related complications were found in all cases.The mean operation time was 74.0± 15.5 minutes.The average blood loss was 122.4±28.8 ml.All patients involved achieved solid fusion at the last followup (12 months post-operation) with no cage migration.Significant differences were observed between the pre-and post-operation status,with respect to the back pain VAS,leg pain VAS and ODI scores.The post-operative lumbar lordosis,disc height on the operation level and foraminal height on the operation level,were also significantly improved when compared with the pre-operative ones.Conclusion MO-ALLIF with self-anchored stand-alone PEEK cage is a modification of both anterior lumbar interbody fusion and oblique lumbar interbody fusion,which is safe and effective in some revision lumbar surgery with minor surgical trauma,low access-related complication rates,and satisfactory clinical and radiological results.

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