两种不同手术入路固定融合治疗腰椎管狭窄症的对比  

Comparison of two instrumented fusions for lumbar spinal stenosis

作　　者：王正安 曾忠友[2] 宋永兴[2] 张建乔[2] 籍剑飞[2] 裴斐[2] 俞伟[2] 宋国浩[2] WANG Zheng-an;ZENG Zhong-you;SONG Yong-xin;ZHANG Jian-qiao;JI Jian-fei;PEI Fei;YU Wei;SONG Gou-hao(Department of Orthopaedics,The First Hospital of Jaxing City,Jaxing 314000,China;The Second Department of Orthopaedics,Armed Police Corps Hospital of Zhejiang Province,Jaxing 314000,China)

机构地区：[1]浙江省嘉兴市第一医院骨科,浙江省嘉兴市314000 [2]武警部队骨科中心武警浙江省总队医院骨二科,浙江省嘉兴市314000

出　　处：《中国矫形外科杂志》2019年第11期986-990,共5页Orthopedic Journal of China

摘　　要：[目的]比较肌间隙入路通道下和正中切口入路下减压融合治疗腰椎管狭窄症的临床效果。[方法]回顾性分析2013年1月~2016年12月手术治疗的腰椎管狭窄症患者58例,其中采用肌间隙入路28例,后路正中切口30例。观察并对比其临床结果、影像结果、并发症情况。[结果]两组病例均顺利完成手术,但两组各发生1例神经根损伤;肌间隙组发生硬脊膜撕裂2例,椎弓根入点处骨折2例;正中切口组发生硬脊膜撕裂1例,椎弓根入点处骨折3例。肌间隙组术中出血量、术后切口引流量和术后72 h腰部切口VAS评分方面优于正中切口组(P<0.05),但手术时间肌间隙组长于正中切口组(P<0.05)。两组病例获得12~36个月的随访,两组病例JOA评分末次随访与术前相比均有明显改善(P<0.05)。肌间隙入路组椎弓根螺钉位置不良率低于正中切口组(P<0.05);两组椎间隙高度术后均较术前有明显增加(P<0.05),但在随访过程中出现明显丢失(P<0.05)。术后1年肌间隙入路组多裂肌面积和等级优于正中切口组(P<0.05)。椎间融合率肌间隙组为96.49%,正中切口组为96.72%。[结论]肌间隙入路通道下操作与正中切口入路相比有较多优势,如切口小、视野清晰恒定、出血少、软组织损伤轻、恢复快等,但存在学习曲线。[Objective] To compare the clinical outcomes of decompression and instrumented fusion through intermuscular approach by channel versus conventional posterior midline approach for lumbar spinal stenosis.[Methods] A retrospective study was conducted on 58 patients who underwent surgical treatment for lumbar spinal stenosis from Jan 2013 to Dec 2016. Of them, 28 patients had the operation performed through intermuscular approach by channel, while the remaining 30 patients had surgical procedure conducted though the conventional posterior midline approach. The clinical consequences, complication and image data were compared between the two groups.[Results] All patients in both groups had operation performed smoothly, although never root injuries occurred in 1 patient of the intermuscular group and 1 patient of midline group, dural tear occurred in 2 patients of the intermuscular group and 1 patient of the midline group, the inserting point fractures of the pedicles happened in 2 patients of the intermuscular group and 3 patients of the midline group. The intermuscular group proved significantly superior to the midline group regarding to intraoperative blood loss, postoperative drainage volume and VAS score at 72 hours postoperatively(P<0.05), despite of the fact that the intermuscular group spent significantly longer operation time than the midline group(P<0.05). The follow-up period lasted for 12~36 months. The JOA scores significantly increased over time in both groups(P<0.05). In term of radiographic evaluation, the intermuscular group got significantly lower rate of pedicle screw malposition than the midline group(P<0.05). The height of involved intervertebral spaces significantly increased postoperatively compared those before operation(P<0.05), nevertheless there were significant loss of the height of intervertebral space at the latest follow-up in both group(P<0.05). At 1 year after operation, the intermuscular group had significantly greater multifidus area than the midline group(P<0.05).In addition, the inte

关 键 词：腰椎管狭窄 固定融合术 肌间隙入路 正中入路 

分 类 号：R687[医药卫生—骨科学]