经椎间孔外腰椎间融合术治疗腰椎退变性疾病18例体会  

Experience in the treatment of 18 cases of lumbar degenerative diseases withextraforaminal lumbar interbody fusion technique

作　　者：朱凌 谢维 邓昶 杨波 陈祝江 高学伟 李绪贵 ZHU Ling;XIE Wei;DENG Chang(Department 1 of Spine Surgery,Hubei 672 Orthopaedics Hospital of Integrated Chinese&Western Medicine,Wuhan 430079,China)

机构地区：[1]湖北六七二中西医结合骨科医院脊柱外科一病区,武汉430079

出　　处：《临床外科杂志》2020年第10期970-973,共4页Journal of Clinical Surgery

摘　　要：目的观察经椎间孔外腰椎间融合术(ELIF)治疗腰椎退变性疾病的临床疗效。方法 2017年1月~2019年1月我院脊柱外科治疗的腰椎退变性疾病病人18例,采用ELIF技术进行双侧固定。根据手术时间、术中出血量、术后并发症、腰疼痛视觉模拟评分(VAS)、JOA评分、影像学检查分别于术前、术后1周、3个月、6个月、1年5个时间点进行随访以评定疗效;根据CT评价椎间融合情况。结果 18例病人均顺利完成手术并获随访,平均手术时间(91.06±5.08)分钟,术中出血量(131.89±8.65)ml。术后末次VAS及JOA评分与术前相比均改善明显,差异有统计学意义(P<0.05)。术后未发生神经损伤、硬膜破裂等严重并发症,1例出口根受牵拉刺激经对症治疗1周后缓解。末次随访无融合器移位、下沉、内固定失败,融合情况根据Bridewell评价标准,均达到Ⅰ~Ⅱ级融合,植骨融合时间平均为6.5个月。结论采用ELIF技术进行双侧固定治疗部分腰椎退行性疾患,疗效理想,可减少手术创伤。Objective To observe the clinical effect of extraforaminal lumbar interbody fusion(ELIF) technique in the treatment of lumbar degenerative diseases.Methods Data of 18 patients of lumbar degenerative diseases were treated by bilateral fixation via ELIF technique in the department of spinal surgery of our hospital from January 2017 to January 2019 were retrospectively analyzed.According to the operation time,intraoperative blood loss,postoperative complications,visual analogue scale(VAS),JOA score and imaging examination of lumbar pain,all patients were followed up before operation,1 week,3 months,6 months and 1 year after operation to evaluate the curative effect.According to the CT,the intervertebral fusion was evaluated.Results All the 18 patients were followed up successfully.The average operation time was(91.06±5.08)min,and the intraoperative blood loss was(131.89±8.65)ml.Compared with preoperative parameters,the scores of VAS and ODI decreased significantly at the final follow-up(P<0.05).No serious complications such as nerve injury and dural rupture occurred postoperatively.One patient was stimulated by traction and relieved after symptomatic treatment for 1 week.At the last follow-up,no cage displacement,subsidence and internal fixation failure were found.According to bridewell evaluation standard,all the patients achieved grade I-Ⅱ fusion,and the average time of bone graft fusion was 6.5 months.Conclusion The ELIF technique for bilateral fixation in the treatment of some lumbar degenerative diseases has ideal curative effect,can reduce surgical trauma.It is in line with the concept of rapid rehabilitation and is worthy of further promotion and application.

关 键 词：腰椎退行性疾病 经椎间孔外腰椎间融合技术 双边椎弓根钉固定 

分 类 号：R687.3[医药卫生—骨科学]