肌间隙入路通道下固定融合治疗复发性腰椎间盘突出症  

Channel-assisted fixation and interbody fusion in treating recurrent lumbar disc herniation by muscle-splitting approach

作　　者：曾忠友[1] 张建乔[1] 毛克亚[2] 宋永兴[1] 范时洋 俞伟[1] 裴斐[1] 王海峰 ZENG Zhong-you;ZHANG Jian-qiao;MAO Ke-ya;SONG Yong-xing;FAN Shi-yang;YU Wei;PEI Fei;WANG Hai-feng(The Second Department of Orthopaedics,Hospital of Coast Guard General Corps of Armed Police Forces,Jiaxing314000,Zhejiang,China)

机构地区：[1]武警部队骨科中心武警海警总队医院骨二科,浙江嘉兴314000 [2]解放军总医院骨科,北京100853

出　　处：《中国骨伤》2021年第4期304-314,共11页China Journal of Orthopaedics and Traumatology

摘　　要：目的:探讨肌间隙入路通道下单侧椎弓根螺钉联合对侧椎板关节突螺钉固定并椎间融合器植骨治疗复发性腰椎间盘突出症的临床价值和安全性。方法:回顾性分析2012年6月至2017年12月收治的51例复发性腰椎间盘突出症的临床资料。男32例,女19例;年龄34~64(51.11±7.28)岁;L4,538例,L5S113例;均有腰痛病史,其中3例伴双下肢放射痛,48例伴一侧下肢放射痛。24例患者采用正中切口入路单侧椎弓根螺钉联合对侧椎板关节突螺钉固定并椎间融合器植骨治疗(正中切口组),27例采用肌间隙入路通道下单侧椎弓根螺钉联合对侧椎板关节突螺钉固定并椎间融合器植骨治疗(肌间隙组)。记录两组患者手术时间、术中出血量、术后引流量和切口长度;采用视觉模拟评分法(visual analogue scale,VAS)对术后72 h腰部切口疼痛进行评分,采用JOA下腰痛评分系统评定术前及末次随访时两组患者腰椎功能;通过影像学资料观察术前、术后3~5 d和末次随访时病变节段椎间隙高度的变化,术前和末次随访时腰椎冠状面和矢状面Cobb角变化,术前和术后12个月多裂肌面积和多裂肌脂肪组织沉积等级,术后椎弓根螺钉和椎板关节突螺钉位置,以及椎间融合情况;比较两组患者并发症发生情况。结果:两组患者手术时间比较差异无统计学意义(P>0.05)。肌间隙组在切口长度、术中出血量和术后引流量方面优于正中切口组(P<0.05)。术后72 h腰部切口疼痛VAS评分正中切口组1.61±0.54,肌间隙组0.76±0.28,两组比较差异有统计学意义(P<0.05)。所有患者获得随访,时间12~84(43.50±15.84)个月。末次随访时两组JOA评分均较术前明显改善(P<0.05)。椎弓根螺钉位置不良率:正中切口组6.25%(3/48),肌间隙组9.26%(5/54),两组差异无统计学意义(P>0.05)。椎板关节突螺钉位置不良率:正中切口组12.50%(3/24),肌间隙组18.52%(5/27),两组差异有统计学意义(P<0.05)。两组�Objective:To explore the clinical value and safety of unilateral pedicle screw fixation combined with contralateral translaminar facet screw fixation and interbody fusion by muscle-splitting approach treatment of recurrent lumbar disc herniation.Methods:The clinical data of 51 patients with recurrent lumbar disc herniation treated from June 2012 to December 2017 were retrospectively analyzed.There were 32 males and 19 females,aged 34 to 64 years with an average of(51.11±7.28)years.Lesions invoved L4,5 in 38 cases and L5S1 in 13 cases.All patients had a history of lower back pain and radiation pain of lower limbs(3 bilateral and 48 unilateral)and underwent unilateral pedicle screw combined with contralateral translaminar facet screw fixation and interbody fusion,among which 24 patients were treated through median incision approach(median incision group);other 27 patients were treated through muscle-splitting approach with channel-assisted exposure(muscle-splitting approach group).Operation time,intraoperative blood loss,postoperative drainage and incision length of the two groups were recorded.Visual analogue scale(VAS)was used to score the pain of lumbar incision at 72 h after operation,and JOA low back pain scoring system was used to evaluate the lumbar function preoperatively and at final follow-up.Imaging data were analyzed,including the changes in the height of intervertebral space of diseased segment before operation,3 to 5 days after operation,and at final follow-up;Cobb angle changes in the coronal and sagittal planes of lumbar spine preoperatively and at final follow-up;multifidus area and multifidus fatty tissue deposition grade before and 12 months after operation;postoperative pedicle screw and laminar process screw position and intervertebral fusion condition.The complications of the two groups were compared.Results:There was no statistical difference in operation time between two groups(P>0.05).Muscle-splitting approach group was better than median incision group in light of incision length,intraope

关 键 词：腰椎间盘突出症 复发 脊柱融合术 

分 类 号：R681.4[医药卫生—骨科学]