后正中入路联合Wiltse入路治疗腰椎间盘突出症合并腰椎失稳的临床疗效  

Clinical curative effects of surgery through posterior median approach combined with Wiltse approach for treatment of lumbar disc herniation with lumbar instability

作　　者：杨广辉[1] 潘玉林[1] 郭小伟[1] 张怀栓[1] 张猛[1] 李宝田[1] 杨柳 YA NG Guanghui;PAN Yulin;GUO Xiaowei;ZHANG Huaishuan;ZHANG Meng;LI Baotian;YANG Liu(Zhengzhou Orthopedic Hospital,Zhengzhou 450052,Henan,China)

机构地区：[1]郑州市骨科医院,河南郑州450052

出　　处：《中医正骨》2020年第8期17-23,共7页The Journal of Traditional Chinese Orthopedics and Traumatology

摘　　要：目的:探讨后正中入路联合Wiltse入路治疗腰椎间盘突出症合并腰椎失稳的临床疗效。方法:回顾性分析接受椎弓根钉棒系统内固定联合改良经椎间孔减压椎间植骨融合术治疗的61例腰椎间盘突出症合并腰椎失稳患者的病例资料,其中采用后正中入路联合Wiltse入路28例、后正中入路33例。男32例,女29例。年龄(53.36±16.24)岁。病变部位,L3~45例、L4~536例、L5S120例。比较2组患者手术时间、术中出血量和术后引流量,分别比较术前、术后12个月2组患者的腰腿部疼痛视觉模拟量表(visual analogue scale,VAS)评分和Oswestry功能障碍指数(Oswestry disability index,ODI),并分别比较术前和末次随访时2组患者的腰椎凹陷值。结果:①一般指标。61例患者椎间隙植骨均获得骨性融合,其中52例术后3个月获得骨性融合、9例术后6个月获得骨性融合。2组患者手术时间比较,差异无统计学意义[(115±12)min,(119±10)min,t=-1.526,P=0.132];后正中入路联合Wiltse入路组术中出血量和术后引流量均小于后正中入路组[(161±27)mL,(343±44)mL,t=-19.003,P=0.000;(161±35)mL,(350±63)mL,t=-14.709,P=0.000]。②腰部疼痛VAS评分。术前2组患者腰部疼痛VAS评分比较,差异无统计学意义[(7.1±1.0)分,(7.0±1.1)分,t=0.398,P=0.692];术后12个月,后正中入路联合Wiltse入路组腰部疼痛VAS评分低于后正中入路组[(1.6±0.7)分,(2.8±1.1)分,t=-4.749,P=0.000],2组患者腰部疼痛VAS评分均低于术前(t=25.409,P=0.000;t=14.978,P=0.000)。③腿部疼痛VAS评分。术前和术后12个月,2组患者腿部疼痛VAS评分比较,差异均无统计学意义[(7.5±0.7)分,(7.6±0.8)分,t=-0.674,P=0.503;(1.4±0.4)分,(1.4±0.5)分,t=0.231,P=0.651];术后12个月,2组患者腿部疼痛VAS评分均低于术前(t=38.853,P=0.000;t=33.719,P=0.000)。④ODI。术前2组患者ODI比较,差异无统计学意义[(81.86±5.55)%,(83.21±5.92)%,t=-0.917,P=0.698];术后12个月,后正中入路联合Wiltse入路组ODI�Objective:To explore the clinical curative effects of surgery through posterior median approach combined with Wiltse approach for treatment of lumbar disc herniation(LDH)with lumbar instability.Methods:The medical records of 61 patients who received pedicle screw-rod system internal fixation combined with modified transforaminal decompression and intervertebral bone graft fusion for treatment of LDH and lumbar instability were analyzed retrospectively.Twenty-eight patients were treated through posterior median approach combined with Wiltse approach(group A),and the others were merely treated through posterior median approach(group B).The patients consisted of 32 males and 29 females and ranged in age of 53.36+/-16.24 years.The pathological changes located at L3-4(5),L4-5(36)and L5S1(20).The operative time,intraoperative blood loss and postoperative drainage volume were compared between the 2 groups.The lumbago-leg pain visual analogue scale(VAS)scores and Oswestry disability index(ODI)obtained before the surgery and at 12 months after the surgery and the lumbar indentation values obtained before the surgery and at last follow-up were compared between the 2 groups respectively. Results: All patients in the 2 groups achieved intervertebral osseous bone graft fusion,in which 52 patients achieved osseous fusion at 3 months after the surgery and 9 patients at 6 months after the surgery. There was no statistical difference in operative time between the 2 groups( 115 +/-12 vs 119 +/-10 min,t =-1. 526,P = 0. 132). The intraoperative blood loss and postoperative drainage volume were less in group A compared to group B( 161 +/-27 vs 343 +/-44 m L,t =-19. 003,P = 0. 000;161 +/-35 vs 350 +/-63 m L,t =-14. 709,P = 0. 000). There was no statistical difference in low back pain VAS scores between the 2 groups before the surgery( 7. 1 +/-1. 0 vs 7. 0 +/-1. 1 points,t = 0. 398,P = 0. 692). The low back pain VAS scores were lower in group A compared to group B at12 months after the surgery( 1. 6 +/-0. 7 vs 2. 8 +/-1. 1 points,t =-4

关 键 词：椎间盘移位 腰椎 腰椎失稳 椎旁肌 手术入路 脊柱融合术 椎弓根钉 临床试验 

分 类 号：R687.3[医药卫生—骨科学]