前路腰椎融合术治疗复发性腰椎间盘突出症的临床效果和安全性分析#br#

闫慧博, 金大地, 黎庆初, 邱奕雁, 吴毅, 杨昌盛

中国临床解剖学杂志 ›› 2020, Vol. 38 ›› Issue (5) : 600-604.

中国临床解剖学杂志 ›› 2020, Vol. 38 ›› Issue (5) : 600-604. DOI: 10.13418/j.issn.1001-165x.2020.05.022
临床研究

前路腰椎融合术治疗复发性腰椎间盘突出症的临床效果和安全性分析#br#

  • 闫慧博, 金大地, 黎庆初, 邱奕雁, 吴毅,  杨昌盛
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The efficacy and safety of the surgical treatment of recurrent lumbar disc herniation with anterior lumbar interbody fusion

  • YAN Hui-bo, JIN Da-di, LI Qing-chu, QIU Yi-yan, WU Yi, YANG Chang-sheng 
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摘要

目的 分析前路腰椎融合术治疗复发性腰椎间盘突出症的临床效果和安全性。  方法 回顾性研究前路腰椎融合术治疗复发性腰椎间盘突出症患者12例,记录其VAS(visual analogue scale)、ODI(oswestry disability index)、手术节段椎间隙高度、椎间孔高度、椎间隙矢状面Cobb角、腰椎前凸角、椎间融合情况、并发症等。  结果 患者术后3个月和末次随访的腰痛和腿痛VAS评分及ODI均较术前改善;术后手术节段椎间隙前高度增加3.6 mm(P<0.05);术后手术节段椎间孔高度、矢状面Cobb角和腰椎前凸角均有改善;所有患者椎间植骨融合良好。2名患者发生融合器下沉。  结论 在严格选择适应证的前提下,前路腰椎融合术应用于复发性腰椎间盘突出症的治疗,效果较好,创伤小,术中出血少,围手术期并发症少,安全性较高。

Abstract

Objective To observe the clinical effect and safety of anterior lumbar interbody fusion in the surgical treatment of recurrent lumbar disc herniation. Methods 12 patients of recurrent lumbar disc herniation treated with anterior lumbar interbody fusion were included and analyzed retrospectively. VAS (visual analogue scale), ODI (Oswestry disability index), height of disc space and foramina, the cobb angle of the operated level in the sagittal plane, lumbar lordosis (LL), the status of interbody fusion and the related complications were recorded. Results Osphyalgia and skelagia with VAS score and ODI of 3 months after the operation and the final follow-up had improved. The anterior height of postoperative intervertebral space increased significantly by 3.6 mm (P<0.05). The height of foramina, the Cobb angle of the postoperative intervertebral space and LL also had improved.  The posterior lumber intervertebral fusion were good in all patients. Fusion cage subsidence occurred in 2 patients. Conclusions Surgical treatment for recurrent lumbar disc herniation with anterior lumbar interbody fusion was effective and safe, which had the advantages of minimal trauma, less blood loss during the operation and less complications in perioperative period.

关键词

  / 前路腰椎融合术 /  腰椎间盘突出症 /  疗效 /  安全性

Key words

Anterior lumbar interbody fusion /  Lumbar disc herniation /  Efficacy /  Safety

引用本文

导出引用
闫慧博, 金大地, 黎庆初, 邱奕雁, 吴毅, 杨昌盛. 前路腰椎融合术治疗复发性腰椎间盘突出症的临床效果和安全性分析#br#[J]. 中国临床解剖学杂志. 2020, 38(5): 600-604 https://doi.org/10.13418/j.issn.1001-165x.2020.05.022
YAN Hui-bo, JIN Da-di, LI Qing-chu, QIU Yi-yan, WU Yi, YANG Chang-sheng. The efficacy and safety of the surgical treatment of recurrent lumbar disc herniation with anterior lumbar interbody fusion[J]. Chinese Journal of Clinical Anatomy. 2020, 38(5): 600-604 https://doi.org/10.13418/j.issn.1001-165x.2020.05.022
中图分类号: R681.53   

参考文献

[1] Siepe CJ, Stosch-Wiechert K, Heider F, et al. Anterior stand-alone fusion revisited: a prospective clinical, X-ray and CT investigation[J]. Eur Spine J, 2015, 24(4): 838-851.
[2]  李磊, 邝磊, 陈宇乔, 等. 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[J]. 中华骨科杂志, 2017, 37(20): 1278-1284.
[3] Winder MJ, Gambhir S. Comparison of ALIF vs. XLIF for L4/5 interbody fusion: pros, cons, and literature review[J]. J Spine Surg, 2016, 2(1): 2-8.
[4] Udby PM, Bech-Azeddine R. Clinical outcome of stand-alone ALIF compared to posterior instrumentation for degenerative disc disease: a pilot study and a literature review[J]. Clin Neurol Neurosurg, 2015, 133: 64-69.
[5] Lebow RL, Adogwa O, Parker SL, et al. Asymptomatic same-site recurrent disc herniation after lumbar discectomy: results of a prospective longitudinal study with 2-year serial imaging[J]. Spine (Phila Pa 1976), 2011, 36(25): 2147-2151.
[6] Mamuti M, Fan S, Liu J, et al. Mini-open anterior lumbar interbody fusion for recurrent lumbar disc herniation following posterior instrumentation[J]. Spine (Phila Pa 1976), 2016, 41(18): E1104-E1114.
[7] Phan K, Lackey A, Chang N, et al. Anterior lumbar interbody fusion (ALIF) as an option for recurrent disc herniations: a systematic review and meta-analysis[J]. J Spine Surg, 2017, 3(4): 587-595.
[8]  陆声, 徐永清, 师继红, 等. 腰椎前路手术相关自主神经的解剖及临床意义[J]. 中华骨科杂志, 2008, 28( 5): 387-391.
[9]  孟宪中, 孟宪国. 下腰椎前路手术术后逆行射精的临床观察[J]. 中国骨与关节损伤杂志, 2006, 21(5): 383-384.
[10] Quraishi NA, Konig M, Booker SJ, et al. Access related complications in anterior lumbar surgery performed by spinal surgeons[J]. Eur Spine J, 2013, 22(Suppl 1): S16-S20.
[11] Phan K, Xu J, Scherman DB, et al. Anterior lumbar interbody fusion with and without an "access surgeon": a systematic review and meta-analysis[J]. Spine (Phila Pa 1976), 2017, 42(10): E592-E601.
[12] Mayer HM. A new microsurgical technique for minimally invasive anterior lumbar interbody fusion[J]. Spine (Phila Pa 1976), 1997, 22(6): 691-699.
[13] Phan K, Mobbs RJ. Evolution of design of interbody cages for anterior lumbar interbody fusion[J]. Orthop Surg, 2016, 8(3): 270-277.
[14]Mayer HM, Wiechert K. Microsurgical anterior approaches to the lumbar spine for interbody fusion and total disc replacement[J]. Neurosurgery, 2002, 51(5 Supp l): S159-S165.
[15]Zdeblick TA, David SM. A prospective comparison of surgical approach for anterior L4-L5 fusion: laparoscopic versus mini anterior lumbar interbody fusion[J]. Spine (Phila Pa 1976), 2000, 25(20): 2682-2687.
[16]Chung SK, Lee SH, Lim SR, et al. Comparative study of laparoscopic L5-S1 fusion versus open mini-ALIF, with a minimum 2-year follow-up[J]. Eur Spine J, 2003, 12(6): 613-617.
[17]Regan JJ, Yuan H, McAfee PC. Laparoscopic fusion of the lumbar spine: minimally invasive spine surgery. A prospective multicenter study evaluating open and laparoscopic lumbar fusion[J]. Spine (Phila Pa 1976), 1999, 24(4): 402-411.
[18]Kaiser MG, Haid RW Jr, Subach BR, et al. Comparison of the mini-open versus laparoscopic approach for anterior lumbar interbody fusion: a retrospective review[J]. Neurosurgery, 2002, 51(1): 97-103.
[19]Giang G, Mobbs R, Phan S, et al. Evaluating outcomes of stand-alone anterior lumbar interbody fusion: a systematic review[J]. World Neurosurg, 2017, 104: 259-271.

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