| 斜外侧腰椎融合术联合Smith-Petersen截骨治疗伴矢状面失衡成人退行性脊柱侧凸疗效观察 |
| Efficacy of oblique lumbar interbody fusion combined with Smith-Petersen osteotomy for the treatment of adult degenerative scoliosis with sagittal imbalance |
| 投稿时间：2023-07-25 |
| DOI：10.3969/j.issn.1672-5972.2023.05.001 |
| 中文关键词: 退行性脊柱侧凸 斜外侧腰椎椎间融合术 Smith-Petersen截骨 矢状面失衡 |
| 英文关键词:Degenerative scoliosis Oblique lumbar interbody fusion Smith-Petersen osteotomy Sagittal imbalance |
| 基金项目:国家自然科学基金（82072500，81974351） |
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| 中文摘要: |
| 目的 观察斜外侧腰椎椎间融合术（oblique lumbar interbody fusion, OLIF）联合Smith-Petersen截骨（SPO截骨）对成人退行性脊柱侧凸矢状面失衡矫形效果，并与单纯后路矫形融合手术进行比较。方法 回顾性分析2014年11月至2019年10月华中科技大学同济医学院附属同济医院收治的64例成人退行性脊柱侧凸患者资料，根据手术方式分为OLIF联合SPO组（33例）和单纯后路矫形组（31例）。记录患者的手术时间、术中出血量及术后住院时间；评估术前、术后3个月、术后1年及末次随访的腰痛和腿痛的疼痛视觉模拟评分（visual analogue scale, VAS）、Oswestry功能障碍指数（Oswestry disability index, ODI）；脊柱全长X线评估脊柱侧凸冠状面Cobb角、腰椎前凸角（lumbar lordosis, LL）、骨盆倾斜角（pelvic tilt, PT）、骨盆入射角（pelvic incidence, PI）与腰椎前凸角（LL）差值（PI-LL）、矢状面平衡（sagittal vertical axis, SVA）等情况，并观察随访期内固定相关并发症，包括近端交界性后凸（proximal junctional kyphosis, PJK）、近端交界区失败（proximal junctional failure, PJF）、内固定失败等。结果 所有患者随访24 ～ 51个月，平均（34.38±8.6）个月。OLIF联合SPO组术中出血量及术后平均住院时间低于单纯后路矫形组（P＜0.05），而平均手术时间高于单纯后路矫形组（P<0.001）。两组患者术后腰、腿痛VAS评分及ODI评分较术前有显著下降（P＜0.05），两组间比较差异无统计学意义（P＞0.05）；冠状面参数比较，两组患者术后随访冠状面Cobb角均较术前明显下降，同时OLIF联合SPO组术后及末次随访Cobb角小于单纯后路矫形组（术后1周6.8°±4.5° vs 12.3°±7.3°，末次随访9.1°±7.3° vs 15.2°±11.7°，P＜0.05）。矢状面参数比较，两组术后及末次随访PT、LL、PI-LL及SVA均较术前明显改善（P＜0.05），而OLIF联合SPO组末次随访LL大于单纯后路矫形组（34.3°±6.4° vs 29.6°±8.9°），PI-LL小于单纯后路矫形组（16.4°±5.3° vs 21.9°±11.2°），差异具有统计学意义（P＜0.05）。OLIF联合SPO组PJK、PJF及内固定失败等内固定相关并发症发生率低于单纯后路矫形组（18.2% vs 25.8%），但差异无统计学意义（P=0.461）。结论 OLIF联合Smith-Petersen截骨治疗成人退变性脊柱侧凸安全、有效，其能够提供坚强的前柱支撑，有效地恢复腰椎前凸，纠正矢状面失衡，并且还有助于减少术中出血，促进术后康复。 |
| 英文摘要: |
| Objective To evaluate the clinical and radiological efficacies of supplementing oblique lumbar interbody fusion (OLIF) with Smith-Petersen osteotomy of adult degenerative scoliosis with sagittal imbalance.Methods A total of 64 patients with adult degenerative scoliosis who underwent two different surgeries from November 2014 to October 2019 at Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology were retrospectively reviewed. Thirty-three patients were treated with OLIF and Smith-Petersen osteotomy (combined OLIF and SPO group), and 31 patients were treated with posterior surgery alone (posterior only group). The operation time, intra-operative blood loss and postoperative hospital stay were recorded. The clinical outcomes were assessed by Oswestry disability index (ODI), visual analogue scale (VAS) of low back pain and leg pain. The radiological outcomes were evaluated with lumbar coronal cobb angle, lumbar lordosis (LL), pelvic tilt (PT), mismatch of pelvic incidence and LL (PI-LL), sagittal vertical axis (SVA). Implant-related complications were also assessed.Results The mean follow-up duration of all the patients was (34.38±8.6) months, with an range from 24 to 51 months. Patients in the combined OLIF and SPO group had less intra-operative blood loss [(494.8±64.5) mL vs (747.5±83.0) mL, P<0.001], and shorter postoperative hospital stay [(10.5±2.0) d vs (12.5±1.9) d, P=0.000] than the posterior only group. While patients in the combined OLIF and SPO group had longer operation time [(300.0±30.3) min vs (235.5±16.2) min, P<0.001] than the posterior only group. The VAS scores for low back pain and leg pain, and ODI scores were significantly improved in both groups (P<0.05) compared with that before operation, and there was no statistical difference between the two groups (P>0.05). In comparison of coronal parameters, coronal Cobb were significantly improved after surgery in both groups, and the correction of coronal Cobb in the combined OLIF and SPO group were superior to that in the posterior only group at follow-ups (P<0.05). In comparison of sagittal parameters, PT, LL, PI-LL and SVA were significantly improved in both groups, while the LL at the last follow-up was greater in the combined OLIF and SPO group (34.3°±6.4° vs 29.6°±8.9°, P=0.018), and PI-LL was smaller in the combined OLIF and SPO group (16.4°±5.3° vs 21.9°±11.2°, P=0.017). The implant-related complication rate in the combined OLIF and SPO group was lower than that in the posterior only group, but without statistical difference (18.2% vs 25.8%, P=0.461).Conclusion OLIF combined with Smith-Petersen osteotomy can restore lumbar lordosis and correct sagittal imbalance of ADS effectively, and has advantages of less intraoperative blood loss, faster recovery and fewer implant-related complications. |
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