单侧椎弓根螺钉固定并椎间融合治疗极外侧腰椎间盘突出症  

Unilateral pedicle screw fixation and intervertebral fusion for the treatment of far lateral lumbar disc herniation

作　　者：俞武良[1] 陆建猛[1] 韦勇力[1] 方明[1] 王兴武[1] 欧阳甲[1] 

机构地区：[1]宁波大学医学院附属医院脊柱外科,浙江宁波315020

出　　处：《中国骨伤》2013年第1期29-32,共4页China Journal of Orthopaedics and Traumatology

摘　　要：目的:探讨单侧椎弓根螺钉固定结合单枚Cage椎体间融合治疗极外侧椎间盘突出症的可行性及临床疗效。方法:2007年1月至2011年1月,手术治疗18例极外侧腰椎间盘突出症患者,男13例,女5例;年龄42～73岁,平均58.5岁;均为单节段突出,其中L3,45例,L4,510例,L5S13例。采用单侧显露症状侧关节突及椎板外侧部分,单侧置入椎弓根螺钉,经椎间孔入路切除突出椎间盘及终板软骨,自体骨植骨,斜向植入单枚Cage。术后及随访期间对腰痛和腿痛视觉模拟评分(VAS)与Oswestry功能障碍指数评分进行观察,并与术前进行比较。结果:18例患者均顺利完成手术,未发生手术并发症。平均手术时间105min(85～125min),术中出血量145ml(90～340ml),术后及随访期间腰痛和腿痛VAS与Oswestry功能障碍指数评分,与术前相比均明显改善。经平均23个月(12～48个月)随访,所有患者椎体间融合良好,未发生断钉及Cage移位。结论:单侧椎弓根螺钉固定结合单枚Cage椎体间融合手术具有创伤小、恢复快、缩短手术时间等优点,是治疗极外侧椎间盘突症可供选择的手术方式。Objective ：To explore the feasibility and clinical efficacy of unilateral pedicle screw fixation with transforaminal lumbar interbody fusion （TLIF） for the treatment of far lateral lumbar disc herniation. Methods：From January 2007 to January 2011,18 patients with far lateral lumbar disc herniation underwent a unilateral TLIF procedure in conjunction with posterior unilateral pedicle screw fixation. There were 13 males and 5 females ,ranging in age from 42 to 73 years （means 58.5 years）. All cases had single segment involved 5 cases in L3,4, lO cases in L4.5,3 cases in L5S1. The visual analog scale （VAS） of low back pain and leg pain and Oswestry Disability Index scores were observed in postoperative and followed-up period, and compared with preoperative. Results：The operation of 18 patients was successful, there were no severe complication. The average operative time was 105 rain （85 to 125 min） ,the average amount of blood loss was 145 ml （90 to 340 ml）. During the followed-up, the visual analog scale and Oswestry disability index scores were significant improved compared with preoperative （P〈0.05）. All patients were followed up from 12 to 48 months with an average of 23 months, there was no implant break and displacement in postoperative X-ray. Conclusion：The surgical procedure of unilateral pedicle screw fixation with transforaminal lumbar interbody fusion had the advantage including less invasion, quickly recovery, short operative time, and saving fixation cost, it may provide an alternative treatment for patients with far lateral lumbar disc herniation.

关 键 词：腰椎 椎间盘移位 脊柱融合术 外科手术 

分 类 号：R681.53[医药卫生—骨科学]