腰大肌前下缘入路斜外侧腰椎间融合的并发症

Complications of anteroinferior psoas oblique lateral lumbar interbody fusion

摘要:

[目的] 研究腰大肌前下缘入路行斜外侧腰椎间融合术 （anteroinferior psoasoblique lateral interbody fusion, AIPOLIF）围手术期并发症发生情况。[方法]回顾性分析 2017 年 4 月—2022 年 8 月采用 AIP-OLIF 治疗的腰椎退行性疾病的 143 例患者的临床资料，评价并发症情况与随访结果。[结果]患者均顺利完成手术，手术时间平均（238.5±87.7）min，术中出血量平均（104.1±116.4）ml。共 39 例患者发生并发症，发生率为 19.6%。其中术中出现并发症 12 例（8.4%），包括节段动脉损伤 2 例、腹膜损伤 2 例、胸膜损伤 2 例、硬膜损伤 1 例、终板损伤 5 例；术后早期发生并发症 12 例（8.4%），6 例术后第 1 d 出现左侧大腿前方疼痛、麻木，6 例术后出现轻度髂腰肌、股四头肌无力，均于 1 个月随访时恢复正常。随访时间平均（14.8±4.3）个月，随时间推移，患者 VAS 评分、ODI 评分显著减少（P＜0.05），JOA 评分显著增加（P＜0.05）。15 例患者（10.5%）在术后 1 年复查 X 线片时发现融合器沉降，均为 0 级沉降。[结论]AIP-OLIF 仍可发生术中和术后并发症，应引起重视。

Abstract:

[Objective] To evaluate the complications of anteroinferior psoasoblique lateral interbody fusion (AIP-OLIF) under direct vision and exposure technique. [Methods] A retrospective study was conducted on 143 patients who received AIP-OLIF from April 2017 to August 2022. The complication and follow-up data were evaluated. [Results] All patients had operation performed successfully with operation time of (238.5±87.7) min, and intraoperative blood loss of (104.1±116.4) ml. Complications in total occurred in 39 patients, accounted for 19.6%. Intraoperative complications occurred in 12 cases (8.4%), including segmental artery injury in 2 cases, peritoneal injury in 2 cases, pleural injury in 2 cases, dural injury in 1 case and endplate injury in 5 cases. Early postoperative complications occurred in 12 patients (8.4%), including 6 patients had pain and numbness in the front of the left thigh on the 1st day after surgery, and 6 patients had mild iliopsoas muscle weakness and quadriceps muscle weakness after surgery, whereas all of them recovered to normal at 1-month follow-up. As time went during follow-up period lasted for (14.8±4.3) months, the VAS score and ODI score were significantly decreased (P＜0.05), while JOA score was significantly increased (P＜0.05). In 15 patients (10.5%), the fusion device subsidence was found in images one year after the operation, all of which remained grade 0 subsidence. [Conclusion] AIP-OLIF can still cause intraoperative and postoperative complications, which should be paid attention to.