后路旁肌间隙入路在腰椎手术的临床应用  

Clinical application of posterior paramedian approach in low back surgeries

作　　者：邹德威[1] 吴继功[1] 谭荣[1] 马华松[1] 邵燕翔[1] 彭军[1] 程晓非[1] 

机构地区：[1]解放军第三○六医院骨科全军脊柱外科中心,北京100101

出　　处：《中华外科杂志》2010年第4期271-275,共5页Chinese Journal of Surgery

摘　　要：目的前瞻性评价腰椎手术中应用脊柱后正中旁肌肉间隙入路在神经根减压和减少肌肉损害等方面的作用。方法2007年1月至2008年5月收治30例下腰痛患者，男性19例，女性11例，22～80岁，平均56岁，包括下腰退变8例，腰椎滑脱6例，腰椎间盘突出11例，再次手术5例。采用后正中单一切口，移动至两侧椎旁肌群，经椎旁肌群间隙直接到达上下关节突表面，在上下椎板黄韧带间隙，沿上下关节突内沿逐步切除，向外侧扩大神经根管开口部，进行局限精确但有效的减压，直至显露行走根及椎间隙，不必全部切除上下关节突，更不必破坏棘间韧带、棘上韧带及黄韧带、行椎板切除。撑开调整椎间隙，对滑脱进行复位，进入椎间隙清除髓核，进行椎间植骨融合。结果狭窄椎间隙恢复高度，滑脱获解剖复位。无螺钉植入失当。下腰生理曲度排列好，无神经损伤并发症。本组术后疼痛症状获明显改善，VAS评分由术前7．5降至术后1．5。结论经椎旁肌群间隙入路，可直接到达上下关节突及软性椎管表面，无需行椎板切除减压，在达到解除压迫、缓解症状、稳定脊柱的同时．最大限序的减少创伤．保留脊梓的原电台角犟剖结构．Objective To prospectively evaluate the clinical effects of posterior paramedian approach in nerve root decompression and reducing muscle damage in low back surgeries. Methods Study group included 30 cases treated from January 2007 to May 2008, DDD 8 cases, spondylolisthesis 6 cases, LDH 11 cases, Low back surgery failure re-operation 5 cases. Based on the comprehensive understanding of modern spine anatomy, we abandoned laminectomy in our procedure, applied a mid-waist skin incision, dissect to the paraspinal muscles where you could easily reach the facets by separating between the multifidus and longissimus, enlarge the canal by performing resection along ligamentum flavum and the inner broader of the articular process, remove enough tissue till you could expose the traversing root and the disc space, this method could achieve a limited but precise and effective decompression with not taking out all of the articular process. Once the anatomy mark of the pediele is located （usually would be at the central area of the incision） , pedicle screws placement would be precise and easy without struggling with muscle traction. The following procedures would be Spondylolisthesis reduction, discectomy and interbody fusion. Results Post-op patients of study group all showed significant improvement of pain symptoms, VAS reduced from 7.14 ± 1.8, pre-op to 1.39 -± 0. 72 post-op, narrowed disc space regained height, spondylolisthesis reached anatomic reduction, no complications such as pedicle screw misplacement and nerve root damage were found, the lumbar spine regained it＇s physiological lordosis structure. Significant difference is discovered （ P 〈 0. 001 ） in statistic study concerning the rate of intractable low back pain between pre-op and post-op. Conclusions Applying low back surgery through posterior para-median approach could directly reach the inferior/superior facets and the ＂soft＂ structures of the spinal canal, expose the exact decompression region and anatomy mark of the pedicle in the central

关 键 词：腰椎 手术 旁入路 减压 

分 类 号：R687.3[医药卫生—骨科学]