Chen Enliang, Xu Junjie, Yang Shanzhi, Zhang Qingshun, Yi Honglei, Liang Daxuan, Lan Sibin, Duan Mingyang, Wu Zenghui
Southern Medical University, Guangzhou, People's Republic of China; Department of Orthopedics, Guangzhou General Hospital of Guangzhou Military Command, Guangzhou, People's Republic of China.
Southern Medical University, Guangzhou, People's Republic of China; Department of Orthopedics, Guangzhou General Hospital of Guangzhou Military Command, Guangzhou, People's Republic of China; Institute of Traumatic Orthopaedics of People's Liberation Army, Guangzhou, People's Republic of China.
World Neurosurg. 2019 Feb;122:e969-e977. doi: 10.1016/j.wneu.2018.10.182. Epub 2018 Nov 4.
To examine the subsidence rate in patients undergoing extreme lateral interbody fusion (XLIF) using data from a 2-year retrospective study to assess the effect of supplemental fixation on the stand-alone procedure.
Demographic and perioperative data for all patients who underwent XLIF for degenerative lumbar disorders between June 2012 and January 2016 were collected and divided into 4 groups: the stand-alone (SA), lateral fixation, unilateral pedicle screw, and bilateral pedicle screw (BPS) groups. The disk height (DH), lumbar lordotic (LL) angle, and segmental lordotic (SL) angle were measured preoperatively and 3 days, 3 months, 1 year, and 2 years postoperatively. Clinical outcomes were evaluated using Japanese Orthopaedic Association (JOA) and visual analog scale (VAS) scores. Fusion was defined according to computed tomography scan.
There were 126 vertebrae in 107 patients treated. SL angle, LL angle, and DH significantly increased postoperatively in all groups. Although the preoperative and 2-year postoperative DHs in the SA group were similar, the other measures showed significant differences from baseline at each follow-up visit. No significant effects on SL angle or DH were found in any of the groups. A significant difference in the LL angle was found in the BPS group compared with the other groups. At the last follow-up, high-grade subsidence was found in 26.89% of all cases, the fusion rate was 85.71%, and the VAS and JOA scores were significantly improved in all groups.
Supplemental fixation did not significantly influence cage subsidence or SL angle. Only BPS fixation significantly improved the LL angle. The 2-year fusion rate was satisfactory.
利用一项为期2年的回顾性研究数据，探讨接受极外侧椎间融合术（XLIF）患者的下沉率，以评估辅助固定对单纯手术的效果。
收集2012年6月至2016年1月期间因退行性腰椎疾病接受XLIF手术的所有患者的人口统计学和围手术期数据，并将其分为4组：单纯手术组（SA）、外侧固定组、单侧椎弓根螺钉组和双侧椎弓根螺钉组（BPS）。术前及术后3天、3个月、1年和2年测量椎间盘高度（DH）、腰椎前凸（LL）角和节段性前凸（SL）角。使用日本矫形外科学会（JOA）和视觉模拟量表（VAS）评分评估临床结果。根据计算机断层扫描确定融合情况。
共治疗107例患者的126个椎体。所有组术后SL角、LL角和DH均显著增加。虽然SA组术前和术后2年的DH相似，但其他测量指标在每次随访时与基线相比均有显著差异。所有组对SL角或DH均未发现显著影响。与其他组相比，BPS组的LL角有显著差异。在最后一次随访时，所有病例中有26.89%出现高度下沉，融合率为85.71%，所有组的VAS和JOA评分均显著改善。
辅助固定对椎间融合器下沉或SL角无显著影响。只有BPS固定显著改善了LL角。2年融合率令人满意。
