[1]王志强① 刘晓印 梁思敏 陈振 杨万忠① 戈朝晖**.采用PIVOX系统行斜外侧腰椎椎间融合联合侧方钢板固定治疗腰椎退行性疾病的早期疗效[J].中国微创外科杂志,2022,01(9):705-711.
　Wang Zhiqiang,Liu Xiaoyin*,Liang Simin*,et al.Shortterm Effect of Oblique Lumbar Interbody Fusion Combined With Lateral Plate Fixation With the PIVOX System in the Treatment of Lumbar Degenerative Diseases[J].Chinese Journal of Minimally Invasive Surgery,2022,01(9):705-711.
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采用PIVOX系统行斜外侧腰椎椎间融合联合侧方钢板固定治疗腰椎退行性疾病的早期疗效()
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《中国微创外科杂志》[ISSN:1009-6604/CN:11-4526/R]

卷:
01
期数:
2022年9期
页码:
705-711
栏目:
临床研究
出版日期:
2023-01-13

文章信息/Info

Title:
Shortterm Effect of Oblique Lumbar Interbody Fusion Combined With Lateral Plate Fixation With the PIVOX System in the Treatment of Lumbar Degenerative Diseases
作者:
王志强① 刘晓印 梁思敏 陈振 杨万忠① 戈朝晖**
(宁夏医科大学总医院骨科，银川750001)
Author(s):
Wang Zhiqiang;  Liu Xiaoyin*;  Liang Simin*;  et al.
*Department of Orthopaedics, General Hospital of Ningxia Medical University, Yinchuan 750001, China
关键词:
退行性疾病; 侧方钢板; 脊柱融合
Keywords:
Degenerative disease; Lateral plate; Spinal fusion
文献标志码:
A
摘要:
目的探讨斜外侧腰椎椎间融合联合侧方钢板固定(oblique lumbar interbody fusion combined with lateral plate fixation，OLIFLP)治疗单节段腰椎退行性疾病的近期疗效。方法回顾性分析2020年5月~2021年1月25例使用PIVOX系统行OLIFLP治疗单节段腰椎退行性疾病的临床资料。均为单节段病变，其中L3/4节段9例，L4/5节段16例。记录手术时间、术中出血量和并发症；术后第1天、6个月、12个月拍摄腰椎X线片和MRI，在X线侧位片上测量椎间隙高度、椎间孔高度、椎间孔面积；在MRI T2WI轴位像上测量椎管面积；术后3个月复查腰椎CT评价椎间融合情况。通过术后1、6、12个月腰痛和腿痛的视觉模拟评分(Visual Analogue Scale，VAS)、Oswestry功能障碍指数(Oswestry Disability Index，ODI)和改良MacNab标准评估临床疗效。结果随访12~17(14.3±1.7)月。腰痛、腿痛VAS评分和ODI术前分别为(6.0±1.2)分、(6.0±09)分和(60.4±4.7)％，术后12个月下降至(2.4±0.6)分、(2.4±0.5)分和(28.0±8.2)％，差异均具有统计学意义(F=117.977、186.468、163.442，均P=0.000)。按照改良MacNab标准，优20例，良3例，可2例，优良率92%(23/25)。术后椎间隙高度、椎间孔高度、椎间孔面积和椎管面积均较术前明显增加(F=382.019、345.856、828.641、918.444，均P=0.000)，术后6、12个月与术后第1天对比均无统计学差异(均P>0.05)。术后3个月椎间融合率为88%(22/25)，术后12个月均达骨性融合。融合器沉降率24%(6/25)，为0级沉降，未产生临床症状。总体并发症发生率16%(4/25)，包括侧方钢板移位1例，腰大肌无力1例，大腿前侧疼痛2例，无螺钉断裂、终板塌陷、重要脏器损伤等并发症发生。结论PIVOX系统行OLIFLP治疗单节段腰椎退行性疾病的近期疗效满意。
Abstract:
ObjectiveTo evaluate the shortterm effect of oblique lumbar interbody fusion (OLIF) combined with lateral plate fixation (OLIFLP) in the treatment of singlesegment lumbar degenerative diseases (LDD).MethodsClinical data of 25 patients with single segmental LDD treated by OLIFLP with the PIVOX system in our hospital from May 2020 to January 2021 were analyzed retrospectively. All the patients were single segment LDD, including 9 cases of L3/4 segment and 16 cases of L4/5 segment. The operation time, intraoperative blood loss and complications were recorded. Lumbar Xray and MRI were taken on the first day and at 6 months and 12 months after operation. The disk height (DH), foraminal height (FH), and intervertebral foramen area (IFA) were measured on lateral Xray films, and the crosssectional area (CSA) was measured on MRI T2WI axial images. The interbody fusion was evaluated according to CT at 3 months after operation. The clinical effect was evaluated by the Visual Analogue Scale (VAS) of low back pain and leg pain and the Oswestry Disability Index (ODI) at 1, 6 and 12 months after operation, and the modified MacNab criteria.ResultsAll the patients were followed up for 12-17 months (mean, 14.3±1.7 months). The VAS of low back pain and leg pain and the ODI decreased from (6.0±1.2), (6.0±0.9), and (60.4±4.7)% preoperation to (2.4±06), (2.4±0.5), and (28.0±8.2)% at 12 months postoperation, respectively. The differences were statistically significant (F=117.977, 186.468, and 163.442, all P=0.000). According to the modified MacNab criteria, there were 20 cases of excellent outcomes, 3 cases of good, and 2 cases of fair, the excellent and good rate being 92% (23/25). The DH, FH, IFA, and CSA were significantly improved after operation (F=382.019, 345.856, 828.641, and 918.444, all P=0.000), and had no significant differences between 6 and 12 months postoperation and the first day after operation (all P>0.05). At 3 months after operation, the interbody fusion rate was 88% (22/25). Bony fusion was achieved at 12 months after operation in all the patients. The cage subsidence rate was 24% (6/25), which was grade 0 subsidence and had no clinical symptoms. The overall incidence of complications was 16% (4/25), including lateral plate displacement in 1 case, psoas muscle weakness in 1 case, and anterior thigh pain in 2 cases. There were no complications such as screw fracture, endplate collapse, important organ injury and so on. ConclusionShortterm effect of OLIFLP with PIVOX system in the treatment of singlesegment LDD is satisfactory.

参考文献/References:

[1]Liu C,Wang J,Zhou Y.Perioperative complications associated with minimally invasive surgery of oblique lumbar interbody fusions for degenerative lumbar diseases in 113 patients.Clin Neurol Neurosurg,2019,184:105381.
[2]张盼可，朱广铎，任志楠，等.斜外侧与后路腰椎间融合治疗腰椎融合术后邻近节段退变性疾病的比较.中国微创外科杂志,2022,22(1):7-13.
[3]林捷,莫志英.单独椎间融合治疗退行性腰椎疾病的研究进展.中国微创外科杂志,2021,21(9):853-857.
[4]Xue H,Tu Y,Cai M.Comparison of unilateral versus bilateral instrumented transforaminal lumbar interbody fusion in degenerative lumbar diseases.Spine J,2012,12(3):209-215.
[5]Lee GY,Lee JW,Choi HS,et al.A new grading system of lumbar central canal stenosis on MRI:an easy and reliable method.Skeletal Radiol,2011,40(8):1033-1039.
[6]Bao BX,Zhou JW,Yu PF,et al.Transforaminal endoscopic discectomy and foraminoplasty for treating central lumbar stenosis.Orthop Surg,2019,11(6):1093-1100.
[7]De Kunder SL,van Kuijk S,Rijkers K,et al.Transforaminal lumbar interbody fusion (TLIF) versus posterior lumbar interbody fusion (PLIF) in lumbar spondylolisthesis:a systematic review and metaanalysis.Spine J,2017,17(11):1712-1721.
[8]Marchi L,Abdala N,Oliveira L,et al.Radiographic and clinical evaluation of cage subsidence after standalone lateral interbody fusion.J Neurosurg Spine,2013,19(1):110-118.
[9]Wen J,Shi C,Yu L,et al.Unilateral versus bilateral percutaneous pedicle screw fixation in oblique lumbar interbody fusion.World Neurosurg,2020,134:e920-e927.
[10]Tempel ZJ,Mcdowell MM,Panczykowski DM,et al.Graft subsidence as a predictor of revision surgery following standalone lateral lumbar interbody fusion.J Neurosurg Spine,2018,28(1):50-56.
[11]Fang G,Lin Y,Wu J,et al.Biomechanical comparison of standalone and bilateral pedicle screw fixation for oblique lumbar interbody fusion surgery:a finite element analysis.World Neurosurg,2020,141:e204-e212.
[12]Zhang Z,Fogel GR,Liao Z,et al.Biomechanical analysis of lateral lumbar interbody fusion constructs with various fixation options: based on a validated finite element model.World Neurosurg,2018,114:e1120-e1129.
[13]Liu J,Feng H.Oblique lateral interbody fusion (OLIF) with supplemental anterolateral screw and rod instrumentation:a preliminary clinical study.World Neurosurg,2020,134:e944-e950.
[14]Denhaese R,Gandhi A,Ferry C,et al.An in vitro biomechanical evaluation of a lateral lumbar interbody fusion device with integrated lateral modular plate fixation.Global Spine J,2021,11(3):351-358.
[15]Zhang Y,Shao Q,Yang C,et al.Finite element analysis of different locking plate fixation methods for the treatment of ulnar head fracture.J Orthop Surg Res,2021,16(1):191.
[16]Xu J,Zhuang W,Zheng W,et al. Microscopic ventral neural decompression in oblique lateral interbody fusion.World Neurosurg,2019,128:e315-e321.
[17]Xie T,Wang C,Yang Z,et al.Minimally invasive oblique lateral lumbar interbody fusion combined with anterolateral screw fixation for lumbar degenerative disc disease.World Neurosurg,2020,135:e671-e678.
[18]Guo HZ,Tang YC,Guo DQ,et al.Stability evaluation of oblique lumbar interbody fusion constructs with various fixation options:a finite element analysis based on threedimensional scanning models.World Neurosurg,2020,138:e530-e538.
[19]Fujibayashi S,Hynes RA,Otsuki B,et al.Effect of indirect neural decompression through oblique lateral interbody fusion for degenerative lumbar disease.Spine (Phila Pa 1976),2015,40(3):E175-E182.
[20]Blizzard DJ,Thomas JA.MIS singleposition lateral and oblique lateral lumbar interbody fusion and bilateral pedicle screw fixation:feasibility and perioperative results.Spine (Phila Pa 1976),2018,43(6):440-446.
[21]Zeng ZY,Xu ZW,He DW,et al.Complications and prevention strategies of oblique lateral interbody fusion technique.Orthop Surg,2018,10(2):98-106.
[22]He W,He D,Sun Y,et al.Standalone oblique lateral interbody fusion vs combined with percutaneous pedicle screw in spondylolisthesis.BMC Musculoskelet Disord,2020,21(1):184.
[23]Le TV,Smith DA,Greenberg MS,et al.Complications of lateral plating in the minimally invasive lateral transpsoas approach.J Neurosurg Spine,2012,16(3):302-307.
[24]Dong E,Shi L,Kang J,et al.Biomechanical characterization of vertebral body replacement in situ:effects of different fixation strategies.Comput Methods Programs Biomed,2020,197:105741.
[25]Ge T,Ao J,Li G,et al.Additional lateral plate fixation has no effect to prevent cage subsidence in oblique lumbar interbody fusion.J Orthop Surg Res,2021,16(1):584.

备注/Memo

备注/Memo:
基金项目：2020宁夏重点研发计划项目(2020BEG03034)**通讯作者，Email：myovid@126.com ①(宁夏医科大学研究生院，银川750004)
更新日期/Last Update: 2023-01-13