微创手术治疗Ⅰ、Ⅱ度腰椎滑脱症的疗效观察  

The clinical effects of minimally invasive surgery for grade Ⅰ and Ⅱ lumbar spondylolithesis

作　　者：刘涛[1] 李长青[1] 周跃[1] 王建[1] 黄博[1] 张东[1] 

机构地区：[1]第三军医大学新桥医院骨科,重庆市400037

出　　处：《中国脊柱脊髓杂志》2009年第5期354-359,共6页Chinese Journal of Spine and Spinal Cord

摘　　要：目的:探讨不同微创手术方式治疗Ⅰ、Ⅱ度腰椎滑脱症的临床效果。方法:2004年2月～2007年10月采用3种微创手术治疗Ⅰ、Ⅱ度腰椎滑脱症患者62例,其中27例伴有中央型椎间盘突出、椎管继发性狭窄或双侧侧隐窝狭窄患者应用可扩张通道系统经后路椎体间植骨融合术(A组),20例腰椎滑脱节段伴有椎间盘退变、一侧隐窝或椎间孔狭窄患者在改良内窥镜下经椎间孔椎体间植骨融合联合经皮椎弓根螺钉固定术(B组),15例滑脱节段有明显节段性不稳、椎间盘变性或轻度膨出、临床表现为以腰痛为主而无下肢放射痛患者行前路小切口椎体间植骨融合联合经皮椎弓根螺钉固定术(C组)。参照视觉模拟评分(VAS)系统评价术前、术后疼痛情况,采用Oswestry功能障碍指数(ODI)评价术前、术后腰部功能。结果:A组中1例术后4d发现切口深部血肿而行血肿清除术,术后切口未出现感染;2例术中硬膜撕裂患者未行修补术,术后无明显脑脊液漏。B组1例假关节形成,未行特殊处理。C组1例术后第1天出现腹股沟区间歇性疼痛、大腿外侧感觉麻木,给予营养神经、对症处理,3个月后消失。随访6～28个月,平均15.7个月。3组术后第1天VAS与术前比较及A、B组术后第3天与术后第1天比较均明显降低(P<0.05),A、B组术后1个月与术后第3天比较及C组术后第3天与术后第1天比较无显著性差异(P>0.05),C组术后1个月与术后第3天比较显著降低(P<0.05)。3组患者术后3个月ODI与术前比较、术后12个月与术后3个月比较均明显降低(P<0.05)。A、B、C组术后椎体滑脱复位率分别为94.6%、97.3%、96.6%,术后12个月融合率分别为96.3%、93.6%、100%。结论:采用不同的微创手术个体化治疗Ⅰ、Ⅱ度腰椎滑脱症患者的临床效果明显。Objective：To evaluate the clinical effects of different minimally invasive surgery for individualized management of lumbar spondylolithesis（grade Ⅰ or Ⅱ ）.Method：Between February 2004 and October 2007,a consecutive of 62 patients with lumbar spondylolithesis（grade Ⅰ or Ⅱ ） underwent one-level lumbar interbody fusion procedure of 3 different minimally invasive protocols.Among those cases ,27 cases suffering from lumbar spondylolisthesis accompanied by central lumbar disc hemiation,or secondary spinal canal stenosis,or bilateral lateral recess stenosis underwent PLIF under the guidance of the X-Tube systems （group A）,20 eases suffering from spondylolysis accompanied by intervertebral disc degeneration,or unilateral lateral recess stenosis,or foramen stenosis experienced modified endoscopic combined with percutaneous pedicle screw fixation（group B）,15 cases who complained of mainly low back pain with no leg redicular pain experienced mini invasive ALIF followed by percutaneous pedicle screw fixation clue to lumbar spondylolisthesis combined with significant segmental instability,or disc degeneration,or slight disc bulge（group C）.Pre- and postoperative back pain was assessed by using visual analogue scale （VAS）,and the postoperative lumbar founction was evaluated by Oswestry disability index （ODI）.Result：In group A,one case had deep hematoma under the skin incision at fourth-day postoperatively which necessitated reoperation,and 2 cases with intraoperative dural tear underwent no tear matter repairing.One patient in group B showed pseudoarthrosis while had no clinical symptom.One case having intermittent pain in inguinal region and numbness in lateral side of thigh postoperatively underwent conservative treatment,with symptoms disappeared at 3 months postoperatively.The mean follow-up was 15.7 months（range,6 to 28 months） .In the first day after operation,VAS scores significantly improved in 3 groups compared with preoperatively,while significantly decreased in group A an

关 键 词：腰椎滑脱症 微创 腰椎融合术 经皮椎弓根固定 

分 类 号：R681.5[医药卫生—骨科学] R616[医药卫生—外科学]