Fang Z, Xu Y, Gao F, Liu Z W, Wu W, Li Y, Guo J F, Xiong W, Li F
Department of Orthopedics, Tongji Hospital Affiliated Tongji Medical College of Huazhong University of Science & Technology, Wuhan 430030, China.
Zhonghua Yi Xue Za Zhi. 2020 Jul 21;100(27):2132-2137. doi: 10.3760/cma.j.cn112137-20191212-02709.
To assess the clinical effect of oblique lumbar interbody fusion (OLIF) combined with posterior surgery via Wiltse approach for adult degenerative scoliosis. The clinical data of 27 patients with adult degenerative scoliosis who received OLIF operation from April 2015 to June 2018 in Tongji Hospital were analyzed retrospectively. There were 17 males and 10 females with an average age of (54±11) years. All patients were treated with OLIF combined with pedicle screw fixation via Wiltse approach. Operation time, blood loss and surgery complications were all recorded. Clinical and radiographic evaluation were investigated at 1 week, 3 months of post operation and final follow-up. Visual analog scale (VAS) for low back pain and leg pain, Oswestry disability index (ODI) for low back pain were used to evaluate the clinical efficacy of surgery. Lumbar coronal cobb angle, lumbar lordosis (LL), pelvic tilt (PT), mismatch of PI and PT, sagittal vertical axis (SVA) were investigated with full spine standing X-ray. The data were compared with factor analysis of variance. All patients were followed-up for 6-52 months ((30±5) months). The operation time was (235±33) min, the blood loss was (433±62) ml. VAS for low back pain and eg pain and the ODI were significantly improved from 6.8±1.4, 7.3±1.4 and 71%±11% preoperatively to 1.1±1.2, 1.0±0.9 and 17%±6% at the latest follow-up (115.302,139.855,291.198, all 0.05).Lumbar coronal Cobb angle of patients was reduced from 28°±8° preoperatively to 9°±4° at the latest follow-up (66.352, 0.05). The LL was significantly increased from 20°±11° preoperatively to 33°±7° (17.678, 0.05), and PT, PI-LL and SVA were significantly increased from 31°±6°,35°±12° and (90±29) mm preoperatively to 26°±5°, 21°±6° and (32±17) mm at the latest follow-up (6.211,23.809,53.372, all 0.05). There was no severe vascular andnerve injuries during and after operation. OLIF combined with posterior surgery via Wiltse approach is a safe and effective operation in the treatment of adult degenerative scoliosis with mild to moderate sagittal imbalance, it can correct the coronal and sagittal deformity, and achieve less surgery injury, less complications and good clinical results.
评估斜外侧腰椎椎间融合术（OLIF）联合经Wiltse入路后路手术治疗成人退变性脊柱侧凸的临床效果。回顾性分析2015年4月至2018年6月在同济医院接受OLIF手术的27例成人退变性脊柱侧凸患者的临床资料。其中男性17例，女性10例，平均年龄（54±11）岁。所有患者均接受OLIF联合经Wiltse入路椎弓根螺钉内固定术治疗。记录手术时间、出血量及手术并发症。分别于术后1周、3个月及末次随访时进行临床及影像学评估。采用视觉模拟评分法（VAS）评估腰背痛及腿痛情况，采用Oswestry功能障碍指数（ODI）评估腰痛情况，以评价手术临床疗效。通过全脊柱站立位X线片测量腰椎冠状面Cobb角、腰椎前凸（LL）、骨盆倾斜角（PT）、骨盆入射角（PI）与PT的失配度、矢状面垂直轴（SVA）。采用方差分析比较数据。所有患者随访6 - 52个月（平均（30±5）个月）。手术时间为（235±33）分钟，出血量为（433±62）毫升。腰背痛及腿痛VAS评分和ODI指数从术前的6.8±1.4、7.3±1.4及71%±11%显著改善至末次随访时的1.1±1.2、1.0±0.9及17%±6%（F值分别为115.302、139.855、291.198，P均＜0.05）。患者腰椎冠状面Cobb角从术前的28°±8°降至末次随访时的9°±4°（F = 66.352，P＜0.05）。LL从术前的20°±11°显著增加至33°±7°（F = 17.678，P＜0.05），PT、PI - LL及SVA从术前的31°±6°°、35°±12°及（90±29）毫米显著增加至末次随访时的26°±5°、21°±6°及（32±17）毫米（F值分别为6.211、23.809、53.372，P均＜0.05）。手术中和术后均未发生严重血管及神经损伤。OLIF联合经Wiltse入路后路手术治疗轻度至中度矢状面失衡的成人退变性脊柱侧凸是一种安全有效的手术方法，可矫正冠状面和矢状面畸形，手术创伤小，并发症少，临床效果良好。
