微创后路椎间融合术治疗腰椎退行性疾病的初步研究  

Pilot study on minimally invasive posterior lumbar interbody fusion for lumbar degenerative diseases

作　　者：刘振磊 段婉茹[1] 菅凤增[1] 吴浩[1] 王兴文[1] 王凯 陈赞[1] Liu Zhenlei;Duan Wanru;Jian Fengzeng;Wu Hao;Wang Xingwen;Wang Kai;Chen Zan(Department of Neurosurgery,Xuanwu Hospital,Capital Medical University,Beijing 100053,China)

机构地区：[1]首都医科大学宣武医院神经外科,北京100053

出　　处：《中华神经外科杂志》2018年第9期926-930,共5页Chinese Journal of Neurosurgery

摘　　要：目的初步探讨微创后路椎间融合术（Mis—PLIF）治疗腰椎退行性疾病的有效性和安全性。方法回顾性纳入2016年12月至2017年8月首都医科大学宣武医院神经外科收治的25例腰椎退行性疾病患者，对所有患者采用通过导丝置入皮质骨钉道（CBT）螺钉改进后路椎问融合术（PLIF）的方法进行治疗。术后对所有患者行门诊随访，随访内容为复查CT和MRI，以评估患者椎管面积和椎间高度的改善情况；同时行疼痛视觉模拟评分（VAS）、Oswestry功能障碍评分（ODI）和腰椎日本骨科协会评分（JOA），以评估患者症状的改善情况。结果25例患者的手术时间为174—341min，平均（168±73）min；术中出血量为50～600ml，平均（242±153）ml；单节段手术切口长度为2．5～4．0cm，平均（3．0±1．3）cm。住院时间为5～12d，平均（7．8±3．9）d。术后1例患者出现术区感染，经治疗后痊愈；1例CBT螺钉致峡部骨折并压迫神经根，行二次手术去除压迫。25例患者的随访时间为6—12个月，平均（7．7±2．7）个月。术后椎管面积[（1．21±0．50）cm。]和椎间高度[（1．06±0．15）cm]均较术前[分别为（0．58±0．28）cm2、（0．86±0．20）cm]增加（均P〈0．01）。术后6个月，VAS评分[（2．7±1．8）分]、ODI评分[（9．3±4．7）分]和JOA评分[（21．3±4．9）分]均较术前[分别为（5．7±2．0）分、（21．2±5．6）分、（15．2±3．2）分]明显改善（均P〈0．01）。结论Mis—PLIF是一种有效、安全、微创的手术方式。对于腰椎退行性疾病需行融合手术的患者，可考虑行CBT螺钉内固定结合PLIF的手术治疗。Objective To investigate the efficacy and safety of minimally invasive posterior lumbar interbody fusion （Mis-PLIF） for treatment of lumbar degenerative diseases （LDD）. Methods This study retrospectively reviewed and included 25 patients diagnosed with LDD and treated at Department of Neurosurgery, Xuanwu Hospital, Capital Medical University from December 2016 through August 2017. With microscope and navigation, we used guidewire to insert cortical bone trajectory （CBT） screw and improved PLIF, which was less invasive. CT and MRI examinations, Visual Analog Scale （VAS） , Oswestry Disability Index （ODI） and Japanese Orthopedics Association （JOA） scales were applied at 1 month, 3 months, 6 months and 1 year postoperatively to evaluate the improvement of the patients＇ symptoms. Results Operation duration was 174 -341 （ 168 ± 73 ） minutes. Blood loss was 50 -600 （242 ± 153 ） ml. Incision length was 2.5 - 4.0 （3.0 ±1.3） cm. Hospitalization stay was 5 - 12 （7.8 ± 3.9） days. One patient suffered from surgical site infection and recovered with antibiotics administration. Fracture of pars interarticularis in another patient was reported who underwent revision surgery. Mean follow-up period was 7.7 ±2.7 （6 -12 months）. CT and MRI showed that the transversal area of spinal canal at the stenofie level （1.21 ±0.50 cm2 postoperatively） and intervertebral height （1.06 ±0. 15 cm postoperatively） were improved compared with preoperative measurement （0.58± 0.28 cm2 and 0.86±0.20 cm, respectively, P 〈 0.01 ）. VAS （2.7 ± 1.8）, ODI （9.3 ± 4.7） and JOA （21.3 ± 4.9） at 6 months postoperatively were significantly better than those assessed preoperatively （5. 7 ± 2. 0, 21. 2± 5. 6 and 15. 2 ± 3. 2, respectively, P 〈 0.01 ）. Conclusions Mis-PLIF seems to be efficacious and safe for the management of LDD for short term. PLIF with CBT screw internal fixation could be considered for LDD patients who need fusion.

关 键 词：脊柱疾病 腰椎 显微外科手术 后路椎间融合术 皮质骨钉道螺钉内固定 

分 类 号：R687.3[医药卫生—骨科学]