155例行斜外侧椎间融合手术患者的围手术期并发症：一项回顾性多中心调查的观点与指征
Perioperative Complications in 155 Patients Who Underwent Oblique Lateral Interbody Fusion Surgery: Perspectives and Indications From a Retrospective, Multicenter Survey.
作者信息
Abe Koki, Orita Sumihisa, Mannoji Chikato, Motegi Hiroyuki, Aramomi Masaaki, Ishikawa Tetsuhiro, Kotani Toshiaki, Akazawa Tsutomu, Morinaga Tatsuo, Fujiyoshi Takayuki, Hasue Fumio, Yamagata Masatsune, Hashimoto Mitsuhiro, Yamauchi Tomonori, Eguchi Yawara, Suzuki Munetaka, Hanaoka Eiji, Inage Kazuhide, Sato Jun, Fujimoto Kazuki, Shiga Yasuhiro, Kanamoto Hirohito, Yamauchi Kazuyo, Nakamura Junichi, Suzuki Takane, Hynes Richard A, Aoki Yasuchika, Takahashi Kazuhisa, Ohtori Seiji
机构信息
Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan.
Department of Orthopaedic Surgery, Chiba Aoba Municipal Hospital, Chiba, Japan.
出版信息
Spine (Phila Pa 1976). 2017 Jan 1;42(1):55-62. doi: 10.1097/BRS.0000000000001650.
STUDY DESIGN
A retrospective multicenter survey.
OBJECTIVE
To investigate the perioperative complications of oblique lateral interbody fusion (OLIF) surgery.
SUMMARY OF BACKGROUND DATA
OLIF has been widely performed to achieve minimally invasive, rigid lumbar lateral interbody fusion. The associated perioperative complications are not yet well described.
METHODS
The participants were patients who underwent OLIF surgery under the diagnosis of degenerative lumbar diseases between April 2013 and May 2015 at 11 affiliated medical institutions. The collected data were classified into intraoperative and early-stage postoperative (≤1 mo) complications. The intraoperative complications were then subcategorized into organ damage (neural, vertebral, vascular, and others) and other complications, mainly related to instrumental failure. The collected data were also divided and analyzed based on whether the surgeon was certified to perform the surgery and the incidence of complications in the early (April 2013-March 2014) and late stages (April 2014-May 2015) of OLIF introduction.
RESULTS
In the 155 included patients, 75 complications were reported (incidence rate, 48.3%). The most common complication was endplate fracture/subsidence (18.7%), followed by transient psoas weakness and thigh numbness (13.5%) and segmental artery injury (2.6%). Almost all these complications were transient, except for three patients who had permanent damage: one had ureteral injury and two had neurological injury. Postoperative complications included surgical site infection (1.9%) and reoperation (1.9%). Whether the primary operator was experienced did not affect the incidence of complications. Regarding the introductory stage, the incidence of complications was 50% in the early stage and 38% in the late stage.
CONCLUSION
The overall incidence of perioperative complications of OLIF surgery reached 48.3%, of which only 1.9% resulted in permanent damage. Our analysis based on surgeon experience indicated that the OLIF procedure could be performed without increasing incidence of complications, under the guidance of experienced supervisors.
LEVEL OF EVIDENCE
研究设计
一项回顾性多中心调查。
目的
探讨斜外侧椎间融合术（OLIF）手术的围手术期并发症。
背景数据总结
OLIF已被广泛应用于实现微创、坚固的腰椎外侧椎间融合。相关围手术期并发症尚未得到充分描述。
方法
研究对象为2013年4月至2015年5月期间在11家附属医院接受OLIF手术治疗退行性腰椎疾病的患者。收集的数据分为术中并发症和术后早期（≤1个月）并发症。术中并发症再细分为器官损伤（神经、椎体、血管及其他）和其他并发症，主要与器械故障有关。收集的数据还根据外科医生是否获得该手术认证以及OLIF引入早期（2013年4月至2014年3月）和晚期（2014年4月至2015年5月）的并发症发生率进行分类和分析。
结果
在纳入的155例患者中，共报告了75例并发症（发生率为48.3%）。最常见的并发症是终板骨折/下沉（18.7%），其次是短暂性腰大肌无力和大腿麻木（13.5%）以及节段动脉损伤（2.6%）。除3例出现永久性损伤的患者外，几乎所有这些并发症都是短暂性的：1例输尿管损伤，2例神经损伤。术后并发症包括手术部位感染（1.9%）和再次手术（1.9%）。主刀医生是否有经验并不影响并发症的发生率。在引入阶段，早期并发症发生率为50%，晚期为38%。
结论
OLIF手术围手术期并发症的总体发生率达48.3%，其中仅1.9%导致永久性损伤。我们基于外科医生经验的分析表明，在经验丰富的上级医生指导下，进行OLIF手术不会增加并发症的发生率。
证据级别
3级。
Zotero 插件