显微镜辅助微创前路腰椎间盘切除零切迹融合治疗腰椎退变性疾病  

Microscope-assisted minimally invasive anterior lumbar discectomy and zero-profile fusion for lumbar degenerative diseases`

作　　者：许海委[1] 徐宝山[1] 刘越[1] 黎宁[1] 姜洪丰[1] 胡永成[1] 杜立龙 王涛[1] 马信龙[1] 张凯辉 Xu Haiwei;Xu Baoshan;Liu Yue;Li Ning;Jiang Hongfeng;Hu Yongcheng;Du Lilong;Wang Tao;Ma Xinlong;Zhang Kaihui(Department of Minimally Invasive Spine Surgery,Tianjin Hospital,Tianjin 300211,China)

机构地区：[1]天津市天津医院微创脊柱外科,天津300211

出　　处：《中华骨科杂志》2022年第7期395-402,共8页Chinese Journal of Orthopaedics

基　　金：国家自然科学基金(31670983,82072491);天津市卫健委科技项目(KJ20211)。

摘　　要：目的探讨显微镜辅助微创前路腰椎间盘切除减压零切迹融合术(anterior lumbar discectomy and fusion,ALDF)治疗腰椎退变性疾病的疗效。方法设计、制作前路腰椎撑开器,作用为维持椎间隙撑开并显露椎间隙后缘。2018年6月至2020年12月采用该术式治疗腰椎退变性疾病患者41例,男19例,女22例;年龄29~71岁,平均42.1岁。临床表现均为顽固性腰痛。影像学表现为腰椎间盘明显退变、椎间隙狭窄。腰椎间盘突出伴终板炎7例,腰椎管狭窄伴失稳16例,腰椎滑脱18例。病变节段:L_(2),31例,L_(3),43例,L_(2)~L_(4)1例,L_(4),517例,L_(5)S_(1)19例。L_(2)~L_(4)行腹直肌旁斜切口,L_(4)~S_(1)行正中偏左横切口,腹膜外入路显露椎间盘,切除椎间盘内容物后撑开椎间隙,安置自制撑开器,显微镜下切除突出的椎间盘髓核组织、后纤维环及椎体后缘骨赘行充分减压,椎间植入自锚式融合器。主要观察指标为疼痛视觉模拟评分(visual analogue scale,VAS)、Oswestry功能障碍指数(Oswestry disability index,ODI)、椎间隙高度、椎间隙前凸角度及滑脱率。结果41例均顺利完成手术,手术时间70~120 min,平均为90 min;术中出血量15~70 ml,平均为30 ml;均未发生神经或血管损伤等严重并发症。术后随访时间为12~36个月,平均18个月。末次随访时VAS评分自术前(6.4±2.3)分降低至(1.1±0.9)分,ODI自术前44.9%±16.9%降低至5.8%±4.7%,椎间隙高度自术前(7.2±2.8)mm恢复至(12.1±2.1)mm,椎间隙前凸角度自术前6.9°±4.8°恢复至10.1°±4.6°。末次随访时X线片示椎间隙高度、椎间隙前凸角度均明显恢复,融合器明显无移位或下沉,植骨块模糊。18例滑脱患者滑脱率自术前16.6%±9.3%降至7.6%±5.3%,平均改善率为54.2%。结论显微镜辅助微创ALDF治疗腰椎退变性疾病能够达到充分减压和零切迹重建,近期效果优良。Objective To evaluate the value and efficacy of microscope-assisted minimally invasive anterior lumbar discectomy and zero-profile fusion(ALDF)for lumbar degenerative diseases.Methods Anterior lumbar distractors were designed to maintain the distraction of intervertebral space and expose the posterior edge of the intervertebral space.From June 2018 to December 2020,41 cases of lumbar degenerative diseases were treated with this operation,including 19 men and 22 women,aged 29-71 years old(average 42.1 years old).All patients had intractable low back pain.Imaging examination showed lumbar disc degeneration with narrow intervertebral space,including disc herniation with Modic changes in 7 cases,spinal stenosis with instability in 16 cases and spondylolisthesis in 18 cases.The involved levels included L_(2),3 in 1 case,L_(3),4 in 3 cases,L_(2)-L_(4)in 1 case,L_(4),5 in 17 cases and L_(5)S_(1)in 19 cases.An incision was taken that was pararectus for L_(2)-L_(4)and transverse for L_(4)-S_(1),with the intervertebral disc exposed via extraperitoneal approach.The intervertebral space was released and distracted after discectomy in intervertebral space,and self-made distractors were used to maintain the space.Under microscope,the herniation,posterior annulus and osteophyte were removed for sufficient decompression,with a suitable self-anchoring cage implanted into the intervertebral space.The visual analogue score(VAS),Oswestry dysfunction index(ODI),intervertebral space height,lordosis angle and spondylolisthesis rate were evaluated.Results Operations were performed successfully in all the patients.The operation time was 70-120 min with an average of 90 min,and the intraoperative blood loss was 15-70 ml with an average of 30 ml.No severe complication such as nerve or blood vessel injury occurred.The patients were followed up for 12 to 36 months,with an average of 18 months.At the last follow-up,VAS decreased from 6.4±2.3 to 1.1±0.9,and ODI decreased from 44.9%±16.9%to 5.8%±4.7%.Intervertebral space height recovered fr

关 键 词：腰椎 椎间盘退行性变 脊柱融合术 外科手术 微创性 

分 类 号：R687.3[医药卫生—骨科学]