内镜下经椎间孔腰椎椎体间融合术治疗退变性腰椎滑脱症  

Treatment of degenerative lumbar spondylolisthesis by transforaminal lumbar interbody fusion with microendoscopic surgery

作　　者：周炜[1] 李立钧[1] 谭军[1] 

机构地区：[1]同济大学附属上海市东方医院骨科,上海200120

出　　处：《中国骨伤》2010年第4期251-253,共3页China Journal of Orthopaedics and Traumatology

摘　　要：目的:探讨后路内镜下(X-Tube)经椎间孔腰椎椎体间融合术治疗退变性腰椎滑脱症的可行性及疗效。方法:2006年1月至2009年1月在X-Tube下经椎间孔腰椎椎体间融合术治疗150例退变性腰椎滑脱症患者,其中男88例,女62例。MeyerdingⅠ度滑脱84例,Ⅱ度滑脱66例。术前、术后1周、术后3个月采用视觉疼痛模拟评分法(VAS)对疼痛进行评估,用改良Prolo评分进行疗效评估。结果:术中发生硬膜囊撕裂3例,局部喷洒生物蛋白胶,术后未发生脑脊液漏;术后出现椎间隙感染和足背伸肌力下降各1例,经对症治疗均恢复正常。术中失血100～450ml,平均210ml;手术时间120～280min,平均160min;150例均获得随访,时间6～36个月,平均15.2个月。VAS评分术前为(7.9±2.1)分;术后1周、术后3个月时分别为(2.2±0.6)分和(3.2±1.1)分,与术前比较均有统计学差异(P<0.01)。根据改良Prolo评分:优133例,良15例,中2例,优良率达98.67%。结论:内镜下经椎间孔腰椎椎体间融合术适用于腰椎不稳、局限性节段椎间盘病变及MeyerdingⅡ度以下腰椎滑脱伴神经根管狭窄的患者,具有手术切口小、出血少、恢复快等优点。Objective：To investigate the effect of treating degenerative lumbar spondylolisthesis by transforaminal lumbar interbody fusion with microendoscopic surgery. Methods：From Jan. 2006 to Jan. 2009,one hundred fifty patients who underwent transforaminal lumbar interbody fusion with microendoscopic surgery were analyzed retrospectively. The diagnosis was degenerative lumbar spondylolisthesis in 84 cases of gradeⅠ,and 66 cases of gradeⅡ. There were 88 males and 62 females. Preoperatively,at 1 week and 3 months postoperatively,the pain was evaluated with visual analogue scale （VAS） scoring system and therapeutic effect was observed with modified Prolo scoring system. Results：In complications,dural tear happened in 3 cases,biological glues were used for dural tear sealing and neither cerebrospinal fluid leak was found. One case suffered from intervertebral infection and muscle weakness of foot was found in one case,either was cured after symptomatic treatment. Operative time averaged 160 minutes（120-280 min）. Estimated blood loss averaged 210 ml （100-450 ml）. The postoperative follow up ranged from 6 to 36 months （averaged 15.2 months）. Preoperatively,at 1 week and 3 months postoperatively,VAS scores were respectively 7.9±2.1,2.2±0.6,3.2±1.1 （P0.01）. The rate of excellent and good was 98.67%（148 / 150） according to modified Prolo scoring system. Conclusion：Microendoscopic surgery transforaminal lumbar interbody fusion technique is indicated for lumbar vertebral instability,localized intervertebral disc disorder and lumbar spondylolisthesis with stenotic nerve root or tube below gradeⅡ. This technique has advantages of minimal invasion and early functional recovery.

关 键 词：显微内窥镜 脊椎滑脱 脊柱融合术 

分 类 号：R681.5[医药卫生—骨科学]