腰椎退行性疾病的改良脊柱内镜下融合术  

A modified endoscopic spinal fusion for lumbar degenerative diseases

作　　者：张建伟 刁文博 高建 马超[1] 戴维享[1] 王兆红[1] 李杰[1] ZHANG Jian-wei;DIAO Wen-bo;GAO Jian;MA Chao;DAI Wei-xiang;WANG Zhao-hong;LI Jie(Department of Spine Surgery,Xuzhou Central Hospital,Xuzhou 221009,China;Department of Orthopedics,Zhoukou Orthopedic Hospital,Zhoukou 466000,China)

机构地区：[1]徐州市中心医院脊柱外科,江苏徐州221009 [2]周口骨科医院骨科,河南周口466000

出　　处：《中国矫形外科杂志》2021年第15期1401-1405,共5页Orthopedic Journal of China

基　　金：江苏省卫生健康委面上项目(编号:H2019023);徐州市科技局重点研发项目(编号:KC19152)。

摘　　要：[目的]介绍脊柱内镜下可视化改良经椎间孔减压融合术(percutaneous endoscopic visualization modified transforaminal lumbar interbody fusion, PEV-MTLIF)治疗腰椎退行性疾病的手术技术与初步临床结果。[方法] 2018年1月—2019年1月,对55例腰椎退行性疾病患者施行PEV-MTLIF术。透视定位标记责任间隙,旁开约4~6 cm,行4个小切口。置入工作套筒、可视环锯和内镜,充分显露关节突及单侧椎板,然后利用可视环锯齿端进行骨性减压,切除责任间隙的椎间盘,置入自体骨与笼架。透视引导下置入4枚椎弓钉,置入双侧棒固定。[结果]所有患者均顺利手术,术中无医源性神经损伤。术后VAS、ODI、JOA评分和SF-36,以及术后椎间孔高度、椎间孔面积及硬膜囊横断面积均较术前显著改善(P<0.05)。末次随访时,采用改良MacNab标准临床效果,优良率为94.5%(53/55),椎间融合率为92.7%(51/55)。[结论] PEV-MTILF术治疗腰椎退行性疾病安全有效,具有创伤小、快速康复等优点,早期疗效满意。[Objective] To introduce the surgical technique and preliminary clinical outcomes of percutaneous endoscopic visualization modified transforaminal lumbar interbody fusion(PEV-MTLIF) for lumbar degenerative diseases. [Methods] From January 2018 to January 2019, 55 patients underwent the PEV-MTLIF for lumbar degenerative diseases. After location of the responsible space by fluoroscopy, 4 small incisions were made about 4~6 cm aside the midline. The working cannula, visual trephine and endoscope were inserted sequentially to fully expose the articular process and unilateral lamina, and then bony decompression was conducted with visual trephine. After that, the responsible intervertebral disc was identified and removed under endoscopic vision, bone autograft and cage were implanted into the intervertebral gap. Finally, 4 pedicle screws were inserted respectively under fluoroscopic guidance, and then bilateral rods were inserted and fixed with the screws. [Results] All patients underwent operation smoothly, without iatrogenic nerve injury during the operation. The VAS,ODI, JOA and SF-36 scores, as well as postoperative foramen height, intervertebral foramen area and cross-sectional area of the dural sac were significantly improved postoperatively compared with those preoperatively(P<0.05). At the last follow-up, the excellent and good rate of clinical results based on the modified MacNab criteria was 94.5%(53/55), while the rate of intervertebral fusion was 92.7%(51/55) on radiographs. [Conclusion] This PEV-MTLIF is safe and effective for lumbar degenerative diseases with advantages of less trauma and rapid recovery, and satisfactory early consequences.

关 键 词：腰椎退行性疾病 脊柱内镜 经椎间孔减压融合术 微创手术 

分 类 号：R681.5[医药卫生—骨科学]