椎间盘镜下减压椎间融合结合经皮椎弓根螺钉固定的疗效观察  

Lumbar canal decompression and interbody fusion under endoscope combined with percutaneous pedicle screw fixation

作　　者：陈金传[1] 刘艺[1] 王延玲[1] 储朝明[1] 李钦亮[1] 陈鸣[1] 

机构地区：[1]江苏省连云港市第一人民医院脊柱外科,222002

出　　处：《中国矫形外科杂志》2012年第5期419-421,共3页Orthopedic Journal of China

摘　　要：[目的]探讨椎间盘镜下后路腰椎管减压、椎间植骨融合结合经皮椎弓根螺钉固定治疗腰椎退变性疾病的早期疗效及临床体会。[方法]2008年2月～2010年12月椎间盘镜下行后路腰椎管减压、椎间植骨加融合器置入、经皮椎弓根螺钉固定治疗25例患者,男11例,女14例,平均53.3岁。腰椎不稳11例,Ⅰ度腰椎滑脱10例,椎间盘突出症术后复发4例。单阶段双侧固定12例,单阶段单侧固定9例,双阶段双侧固定4例。随访观察治疗效果。[结果]手术时间平均170min。术中失血量平均195ml。术后住院时间平均12d。手术切口均一期愈合。随访10～34个月,平均21.7个月。ODI评分术前为(46.55±10.12)分,术后1个月及末次随访时分别为(22.15±8.36)分和(13.24±5.31)分,与术前比较均有显著性差异(P<0.01)。VAS评分术前为(7.15±1.11)分,术后1个月及末次随访时分别为(3.52±1.31)分和(1.45±0.81)分,与术前比较均有显著性差异(P<0.01)。[结论]椎间盘镜下减压、椎间融合结合经皮椎弓根螺钉固定治疗腰椎退变性疾病具有手术切口小、腰骶肌肉剥离范围小、出血少、术后恢复快等优点,可获得良好的近期临床效果,是一种安全有效的微创手术方法。[Objective]To evaluate the early outcomes and clilical experience of treatment of lumbar degenerative disease with percutaneous pedicle screw fixation,lumbar canal decompression and interbody fusion under endoscope.[Methods]From February 2008 to December 2010,25 patients were treated with percutaneous pedicle screw fixation（Sextant system）,lumbar canal decompression,interbody fusion with autograft and cage under endoscope.There were 11 males and 14 females,aged from 42 to 73 years,with an average of 53.3 years.There were 11 patients with lumbar instability,10 with Ⅰ°spondylolisthesis,4 postoperative recurrent of lumbar disc herniation.The VAS and ODI evaluation were adopted to assess the pain relief and patient satisfaction.[Results]The average operative time was 170 minutes,with a mean blood loss of 195 ml and mean postoperative hospital stay of 12 days.One-stage incision healing was obtained in all patients.All the patients were followed up for 10-34 months（average 21.7 months）.The ODI scores were 46.55± 10.12,22.15± 8.36 and 13.24±5.31（P0.01）,and the VAS scores were 7.15±1.11,3.51±1.31 and 1.45±0.81（P0.01） before and one months after operation,and at final follow-up,respectively.[Conclusion]Percutaneous pedicle screw fixation,lumbar canal decompression and interbody fusion under endoscope could achieve satisfactory clinical results in treating lumbar degenerative disease.It is a safe and effective minimally invasive surgical method.

关 键 词：椎间盘镜 腰椎不稳 腰椎滑脱 椎间融合 经皮椎弓根螺钉 

分 类 号：R687.3[医药卫生—骨科学]