全脊柱内镜下椎管减压结合斜外侧入路腰椎间融合术及经皮椎弓根钉治疗伴腰椎滑脱的腰椎管狭窄症  

Full-endoscopic Spinal Surgery Combined with Oblique Lumbar Interbody Fusion (OLIF) and Percutaneous Pedicle Screw for Lumbar Spinal Stenosis with Spondylolisthesis

作　　者：涂计 李文甜[2] 杨述华[1] 张宇坤[1] 华文彬 李帅[1] 王坤[1] 刘伟[3] 宋雨[1] 罗荣锦 杨操[1] Tu Ji;Li Wentian;Yang Shuhua(Department of Orthopaedics,Union Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430022,China;Wuhan Institute of Biological Products Co.Ltd.,Wuhan 430060,China)

机构地区：[1]华中科技大学同济医学院附属协和医院骨科,武汉430022 [2]武汉生物制品研究所病毒性疫苗研究二室,武汉430060 [3]武汉市第一医院骨科,武汉430022

出　　处：《华中科技大学学报（医学版）》2018年第4期437-444,共8页Acta Medicinae Universitatis Scientiae et Technologiae Huazhong

基　　金：国家自然科学基金资助项目(No.81772401;U1603121)

摘　　要：目的探讨全脊柱内镜下椎管减压结合斜外侧入路腰椎间融合术(OLIF)及经皮椎弓根钉治疗伴有腰椎滑脱的腰椎管狭窄症的临床效果。方法回顾性分析2014年12月至2016年6月武汉协和医院骨科应用脊柱内镜结合OLIF及经皮椎弓根钉治疗腰椎管狭窄合并有腰椎滑脱的患者病例资料,其中男6例,女7例;年龄(65.0±4.2)岁(55~80)岁;评估术后影像学改变及临床疗效。影像学改变包括椎间隙高度变化、椎管直径、椎管面积以及椎体滑脱程度等。临床疗效评估包括使用视觉模拟(visual analogue scale,VAS)评分与Oswestry功能障碍指数(Oswestry disability index,ODI)评分评价术后下腰痛、下肢疼痛、麻木等症状。结果全部病例随访6~24个月,平均11.5个月。与术前相比,术后患者椎管面积、椎管直径明显增加,椎间隙高度明显增高,上位椎体滑脱程度明显减小。责任节段椎管面积由术前(83.70±1.24)mm2增加至末次随访(115.80±1.91)mm2。椎间隙高度由术前(12.20±0.58)mm增加至末次随访(14.50±0.37)mm。椎管直径由术前(8.40±0.61)mm增加至末次随访(10.70±0.84)mm。腰椎滑脱程度由术前(14.80±0.77)%减少至末次随访(2.40±0.23)%。术后患者腰腿疼痛症状均明显缓解,日常生活能力改善。VAS评分由术前(7.80±0.79)分降至术后1周(3.15±0.48)分,末次随访为(2.56±0.82)分。ODI评分由术前(53.10±6.45)%降至术后1周(20.80±3.27)%,末次随访为(18.70±5.74)%。结论全内镜下椎管减压结合OLIF及经皮椎弓根钉技术运用多种脊柱微创手段,通过减压、融合、固定、复位实现椎管减压、纠正脊柱不稳,从而治疗伴有脊柱不稳的腰椎管狭窄症。手术创伤小,安全可行,近期疗效满意。Objective To investigate the effect of full-endoscopic decompression combined with oblique lumbar interbody fusion（OLIF）and percutaneous pedicle screw in the treatment of lumbar spinal stenosis with spondylolisthesis.Methods To analyze the clinical records of 13 patients suffering from lumbar spinal stenosis with spondylolisthesis treated by full-endoscopic decompression combined with oblique lumbar interbody fusion（OLIF）and percutaneous pedicle screw during December 2014 to June 2016.Among them,6 were males,7 were females,with the mean age（65.0±4.2）years（range,55-80 years）.Clinical outcomes and image changes were assessed.Image changes include disk height,axial and sagittal spinal canal diameter,crosssectional area,foraminal height,and slipping of upper vertebra.Clincal symptoms including low back pain,leg pain,and lower extremity numbness were evaluated by visual analog scale and the Oswestry Disability Index.Results The patients were followed up for 11.5 months（range,6-24 months）.The disk height sagittal spinal canal diameter and cross-sectional area were（12.20±0.58）mm,（8.40±0.61）mm,（83.70±1.24）mm2,respectively before the operation,and（14.50±0.37）mm,（10.70±0.84）mm,（115.80±1.91）mm2 in the last follow-up.Upper vertebral slipping was significantly decreased from（14.80±0.77）% preoperatively to（2.40±0.23）%in the last follow-up.The pain was relieved and activity of daily living improved in all patients.The VAS scores improved from（7.80±0.79）preoperatively to（3.15±0.48）1 week after operation,and（2.56±0.82）in the last follow-up,the ODI scores decreased from（53.10±6.45）% preoperatively to（20.80±3.27）%1 week after operation,and（18.70±5.74）% in the last follow-up.Conclusion Full-endoscopic decompression combined with OLIF and percutaneous pedicle screw apply multiple spinal micro-trauma strategy and achieve spinal decompression and correction of spinal instability through decompression,fusion,fixation,and restoration.It provides a

关 键 词：斜外侧入路腰椎间融合术 腰椎管狭窄症 腰椎滑脱 微创手术 

分 类 号：R681.5[医药卫生—骨科学]