摘要
目的:探讨Pivox固定系统在斜外侧腰椎椎间融合术(oblique lateral interbody fusion,OLIF)治疗单节段腰椎疾患中的应用及临床疗效.方法:自2020年5月～2021年1月,收集我院采用单纯OLIF(不行后路椎弓根螺钉固定技术)治疗单节段腰椎疾患(盘源性腰痛、腰椎滑脱、腰椎管狭窄)的患者资料,其中男36例,女33例;年龄32～79岁,平均59.1±5.9岁.分为单纯OLIF组(39例)和Pivox+OLIF组(30例),评估两组的围手术期指标:包括切口长度,手术时间,术中出血量,住院时间;在术前、术后1周、1个月、3个月、6个月、12个月时用疼痛视觉模拟评分(visual analogue scale,VAS)和 Oswestry 功能障碍指数(Oswestry disability index,ODI)对两组临床疗效进行评价,评估并比较两组患者手术前后的椎间隙高度、椎间孔纵径和面积以及术后腰椎融合情况.以及比较两组之间并发症情况.结果:所有患者随访12～18个月,平均14.0±0.3个月,两组之间性别、年龄、疾病类型、手术节段、骨密度、体质指数(body mass index,BMI)等方面比较差异均无统计学意义(P＞0.05)o Pivox+OLIF组手术时间大于OL1F组(P＜0.05),而两组之间切口长度、出院时间、术中出血量无统计学差异(P＞0.05).两组组内围手术期VAS评分、ODI比较均为术前高于术后1周及术后1、3、6、12个月(P＜0.05),术后1周及术后1、3、6、12个月时,两组之间VAS评分、ODI比较无统计学差异(P＞0.05).两组组内椎间隙高度、椎间孔纵径和面积术后 1周及术后6、12个月较术前均明显增加(P＜0.05),术后1周及术后6、12个月时,Pivox+OLIF组椎间隙、椎间孔纵径和面积增加值均大于OLIF组,但无统计学差异(P＞0.05).两组均有融合器沉降病例,OLIF组有两例发生融合器移位,Pivox+OLIF组无一例融合器移位,两组之间融合率和并发症发生率无明显差异(P＞0.05).结论:Pivox+OLIF技术治疗单节段腰椎退行性疾病的近期疗效满意,但相对于单纯OLIF,Pivox+OLIF在椎管减压以及融合器下沉方面并无明显优势.
Abstract
Objectives:To explore the clinical use and observe the clinical efficacy of the Pivox system in oblique lateral interbody fusion(OLIF)in treating single-segment lumbar spinal diseases.Methods:The clini-cal data of patients with single-segment lumbar spinal diseases(Discogenic low back pain,lumbar spondylolis-thesis,lumbar spinal stenosis)who underwent OLIF without posterior instrumentation from May 2020 to Jan-uary 2021 in our hospital were collected,including 36 males and 33 females,aged 32-79 years old(59.1±5.9 years).And the patients were divided into OLIF stand-alone group(39 patients)and Pivox+OLIF group(30 pa-tients).The perioperative parameters of the two groups of patients were compared,including incision length,operative time,intraoperative blood loss,and length of hospital stay.The visual analogue scale(VAS)and Os-westry disability index(ODI)were assessed before operation,at 1 week,1,3,6 and 12 months after operation for clinical efficacy.The intervertebral disc height,foraminal height and foraminal area before and after oper-ation,and the fusion rate were evaluated and compared between the two groups.Complications were recorded and compared as well.Results:The patients were followed up for 14.0±0.3 months(12-18 months).No signif-icant differences were found between the two groups in gender,age,disease type,operative level,bone min-eral density(BMD),or body mass index(BMI)(P＞0.05).The operative time in OLIF group was shorter than that in Pivox+OLIF group(P＜0.05),while there were no significant differences in blood loss,incision length and hospital stay(P＞0.05).The VAS score and ODI index in both groups before surgery were higher than those at 1 week,1 month,3 months,6 months,and 12 months after surgery(P＜0.05).No significant differences in VAS and ODI were found at 1 week,1 month,3 months,6 months,and 12 months after surgery between the two groups,respectively(P＞0.05).The intervertebral disc height,foraminal height and foraminal area at postoperative 1 week,6 and 12 months were all greater than those before operation in both groups,while the increase values of intervertebral disc height,foraminal height and foraminal area in Pivox+OLIF group were greater than those in OLIF group at 1 week,and 6 and 12 months after surgery,but without statistical differ-ences(P＞0.05).Cage subsidence occurred in both groups,and cage displacement was noticed in two cases in the OLIF group,while none was there in the Pivox+OLIF group.There were no significant differences in fu-sion rate and incidence of complications between two groups(P＞0.05).Conclusions:The short-term effect of Pivox+OLIF procedure in the treatment of single-segment lumbar degenerative diseases is satisfactory,but comparing with stand-alone OLIF,Pivox+OLIF has no obvious advantage in spinal canal decompression and preventing cage subsidence.
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