腹腔镜辅助下经前后路治疗重度腰椎滑脱症  

Endoscope-assisted combined anterior and posterior procedures for spondylolisthesis

作　　者：张春霖[1] 朱红鹤[1] 李莹[1] 严旭[1] 王铮[1] 陈博光[2] 

机构地区：[1]郑州大学第一附属医院骨科,450052 [2]台湾大学附属医院骨科部

出　　处：《中华骨科杂志》2011年第10期1116-1121,共6页Chinese Journal of Orthopaedics

摘　　要：目的评价腹腔镜辅助下经前后路手术治疗重度（Ⅲ、Ⅳ度）腰椎滑脱症的手术操作方法及临床疗效。方法2007年12月至2010年5月，采用后路椎间盘镜行双侧神经二次减压、经皮椎弓根钉复位及前路腹腔镜下椎间植骨钛板内固定融合治疗Ⅲ、Ⅳ度腰椎滑脱症患者13例，男6例，女7例；年龄18-58岁，平均39．8岁。Ⅲ度滑脱患者11例，Ⅳ度滑脱患者2例。滑脱部位：L4.5 2例，L5S111例。根据滑脱率、滑脱角、椎间隙后高度改变及临床Oswestry功能障碍指数评估疗效。结果术后随访12至36个月，平均21个月。手术时间105-150min，平均125min；出血量200-000ml，平均415ml。滑脱率减小56．9％（术前73.3％±6．1％，术后16.4％±9．5％）；滑脱角减小19．6°（术前27．7°±5．6°，术后8．1°±8．8°）；椎间隙后高度增大7．1mm[术前（2．6±0．8）mm，术后（9．7±3．7）mm]。临床Oswestry功能障碍指数下降19．5分[术前（35．8±5．7）分，术后（16．3±5．2）分]。CT扫描术后1年椎体间均骨性融合。术中发生硬膜囊撕裂1例，切口浅表感染1例。疗效优4例，良8例，可1例。结论腔镜辅助下经前后路手术治疗Ⅲ、Ⅳ度腰椎滑脱症可实现彻底减压及尽可能的解剖复位，前后’内固定协同稳定性好，椎间植骨融合可靠，手术创伤小，临床疗效满意。Objective To evaluate the clinical outcome of endoscope-assisted combined anterior and posterior procedures for grade-Ⅲ and IVspondylolisthesis. Methods From December 2007 to May 2010, 13 patients with grade-Ⅲ and IV spondylolisthesis were treated with two bilateral decompression, percutaneous pedicle screw restoration, intervertebral bone grafting and plate fixation using microendoscopic discectomy and laparoscopy, including 6 males and 7 females with an average age of 39.8 years （range, 18-58 years）. Eleven cases were in grade III spondylolisthesis and two in IV. The lesion location was as follows： 2 cases were at L4.5 and 11 at L5S1. The clinical outcomes were evaluated according to Oswestry disability questionnaire, and the change of radiographic data including slipping degree, slipping angle and posterior height of intervertebral disc. Results The mean follow-up time was 21 months （range, 12-36 months）. The mean operative time was 125 min, with a mean blood loss of 415 ml. Slipping degree decreased 56.9% in average （ from preoperative 73.3%±6.1% to postoperative 16.4%±9.5%）, slipping angle decreased 19.6°（from preoperative 27.7°±5.6° to postoperative 8.1°±8.8° ）, posterior height of intervertebral disc increased 7.1 mm （from preoperative 2.6±0.8 mm to postoperative 9.7 ±3.7 mm）. The clinical outcomes of the Oswestry disability questionnaire decreased 19.5 （from preoperative 35.8±5.7 to postoperative 16.3±5.2）. CT scans demonstrated that solid bony fusion could be obtained in one year after operation. Complications included dural sac tears in 1 case, and superficial incision infection in 1. The results were excellent in 4 cases, good in 8 and fair in 1. Conclusion Endoscope-assisted anterior and posterior procedures for grade-III and IV spondylolisthesis is a reliable method, which can lead to rigid fixation and fusion, and also can achieve thorough decompression and restoration as much as possible.

关 键 词：腹腔镜 脊椎前移 治疗结果 

分 类 号：R687.3[医药卫生—骨科学]