摘要
目的:总结斜外侧椎间融合技术(oblique lateral interbody fusion,OLIF)术后再手术原因和策略,并提出预防性措施.方法:回顾性分析自2015年10月至2019年12月采用OLIF技术治疗失败后再次手术的23例患者资料,男9例,女14例;年龄44～81(61.89±8.80)岁.疾病类型:腰椎间盘退行性病变3例,椎间盘源性腰痛1例,腰椎退行性滑脱6例,腰椎管狭窄症9例,腰椎退行性侧后凸4例.初次手术采用Stand-alone OLIF 16例,OLIF联合后路椎弓根螺钉固定7例.融合节段:单节段17例,2节段2例,3节段4例.均于初次术后3个月内接受了再次手术.再手术方法:予附加后路椎弓根螺钉内固定16例;予后路椎板间隙开窗并融合器调整神经根松解2例、内镜下关节突成形神经根松解1例、后路椎板间隙开窗神经根松解1例、椎弓根螺钉调整1例、椎间孔内镜下探查减压术1例;椎间融合器和椎弓根螺钉翻修1例.采用疼痛视觉模拟评分(visual analogue scale,VAS)和Oswestry功能障碍指数(Oswestry disabil-ity index,ODI)评价并对比再次手术前、末次随访时腰痛、腰椎功能恢复情况,随访过程中观察融合器沉降或再移位现象,以及椎间融合情况.测量并对比初次术前、初次术后、再次手术前、再次手术后3～5 d、再次手术后6个月和末次随访时椎间隙高度的变化.结果:再次手术后患者切口皮肤无坏死、无感染.所有患者获得随访,时间12～48(28.1±7.3)个月.初次术后出现神经损伤及术后神经症状未缓解病例其神经症状于3～6个月完全缓解或恢复.随访过程中未出现椎弓根螺钉系统松动或断裂现象,融合器无进一步移位.椎间隙高度在初次术后均获得明显恢复,但出现早期的快速丢失,经再次手术后,椎间隙高度仍有部分丢失.腰痛VAS由再次术前的(6.20±1.69)分至末次随访时的(1.60±0.71)分(P＜0.05);ODI由再次术前的(40.60±7.01)％恢复至末次随访时的(9.14±2.66)％(P＜0.05).结论:OLIF术后存在因失败而需再次手术风险,再手术原因包括患者术前存在骨量减少或骨质疏松、初次手术采用Stand-alone方式、术中的终板损伤、术中的神经损伤、术后融合器的明显沉降、术后融合器移位等.只要发现及时、处理得当,OLIF术后再手术多能获得较好的临床结果,但仍需加强预防.
Abstract
Objective To summarize the reasons and management strategies of reoperation after oblique lateral interbody fusion(OLIF),and put forward preventive measures.Methods From October 2015 to December 2019,23 patients who under-went reoperation after OLIF in four spine surgery centers were retrospectively analyzed.There were 9 males and 14 females with an average age of(61.89±8.80)years old ranging from 44 to 81 years old.The index diagnosis was degenerative lumbar intervertebral dics diseases in 3 cases,discogenie low back pain in 1 case,degenerative lumbar spondylolisthesis in 6 cases,lumbar spinal stenosis in 9 cases and degenerative lumbar spinal kyphoscoliosis in 4 cases.Sixteen patients were primarily treated with Stand-alone OLIF procedures and 7 cases were primarily treated with OLIF combined with posterior pedicle screw fixation.There were 17 cases of single fusion segment,2 of 2 fusion segments,4 of 3 fusion segments.All the cases underwent reoperation within 3 months after the initial surgery.The strategies of reoperation included supplementary posterior pedicle screw instrumentation in 16 cases;posterior laminectomy,cage adjustment and neurolysis in 2 cases,arthroplasty and neuroly-sis under endoscope in 1 case,posterior laminectomy and neurolysis in 1 case,pedicle screw adjustment in 1 case,exploration and decompression under percutaneous endoscopic in 1 case,interbody fusion cage and pedicle screw revision in 1 case.Visu-al analogue scale(VAS)and Oswestry disability index(ODI)index were used to evaluate and compare the recovery of low back pain and lumbar function before reoperation and at the last follow-up.During the follow-up process,the phenomenon of fusion cage settlement or re-displacement,as well as the condition of intervertebral fusion,were observed.The changes in in-tervertebral space height before the first operation,after the first operation,before the second operation,3 to 5 days after the second operation,6 months after the second operation,and at the latest follow-up were measured and compared.Results There was no skin necrosis and infection.All patients were followed up from 12 to 48 months with an average of(28.1±7.3)months.Nerve root injury symptoms were relieved within 3 to 6 months.No cage transverse shifting and no dislodgement,loosening or breakage of the instrumentation was observed in any patient during the follow-up period.Though the intervertebral disc height was obviously increased at the first postoperative,there was a rapid loss in the early stage,and still partially lost after reopera-tion.The VAS for back pain recovered from(6.20±1.69)points preoperatively to(1.60±0.71)points postoperatively(P＜0.05).The ODI recovered from(40.60±7.01)％preoperatively to(9.14±2.66)％postoperatively(P＜0.05).Conclusion There is a risk of reoperation due to failure after OLIF surgery.The reasons for reoperation include preoperative bone loss or osteoporosis the initial surgery was performed by Stand-alone,intraoperative endplate injury,significant subsidence of the fusion cage after surgery,postoperative fusion cage displacement,nerve damage,etc.As long as it is discovered in a timely manner and handled properly,further surgery after OLIF surgery can achieve better clinical results,but prevention still needs to be strengthened.
维普
万方数据