脊柱内镜辅助下腰椎椎体间融合术治疗L_(5)-S_(1)峡部裂性滑脱:技术要点与临床结果  

Full endoscopic lumbar interbody fusion for the treatment of L_(5)-S_(1) isthmic spondylolisthesis: technical note and preliminary results

作　　者：陈子豪 董健文[1] 刘仲宇[1] 陈瑞强[1] 杨阳[1] 翟正佳 齐佳坤 戎利民[1] CHEN Zi-hao;DONG Jian-wen;LIU Zhong-yu;CHEN Rui-qiang;YANG Yang;ZHAI Zheng-jia;QI Jia-kun;RONG Li-min(Department of Spine Surgery,The Third Affiliated Hospital of Sun Yat-sen University,Guangzhou,Guangdong,510630,China)

机构地区：[1]中山大学附属第三医院脊柱外科,广东省微创脊柱外科质量控制中心,广东省微创脊柱外科工程技术研究中心,广州510630

出　　处：《中国骨与关节杂志》2022年第6期437-444,共8页Chinese Journal of Bone and Joint

摘　　要：目的分析脊柱内镜辅助下腰椎椎体间融合术(镜下融合)治疗L_(5)-S_(1)峡部裂性滑脱的技术要点与临床结果。方法2019年5月至2021年10月,共10例L_(5)-S_(1)峡部裂性滑脱患者于我院接受镜下融合,其中男6例,女4例;年龄40~79岁,平均(57.8±10.4)岁。Meyerding分级Ⅰ度滑脱6例,Ⅱ度滑脱4例(其中2例接近Ⅲ度滑脱,1例为双节段Ⅱ度滑脱行双节段镜下融合);2例单节段滑脱患者合并L_(4-5)椎管狭窄,除镜下融合外同时行L_(4-5)单纯镜下减压。4例经椎间孔入路,6例经关节突入路。术后复查腰椎正侧位X线片及腰椎CT评价减压与内固定情况。术前、术后及末次随访使用腰椎Oswestry功能障碍指数(oswestry disability index,ODI)、腰痛及腿痛的视觉模拟评分(visual analogue scale,VAS)、日本骨科协会(Japanese Orthopaedic Association,JOA)评分评价疗效。随访超过6个月者复查腰椎CT,按照Bridwell标准判断融合情况。结果所有患者均按术前规划完成手术,无中转开放手术。手术时间平均(297.2±87.2)min。住院时间平均(16.0±4.3)天,其中术后住院时间平均(9.4±3.8)天。术后随访时间3~30个月,平均(17.1±10.3)个月。术后及末次随访ODI评分、腰痛及腿痛VAS评分、JOA评分均较术前明显改善,差异有统计学意义(P<0.05)。术后与末次随访影像学滑脱距离、滑脱程度、椎间隙高度与术前比较差异均有统计学意义(P<0.05);术后滑脱节段前凸角较术前明显改善,差异有统计学意义(P<0.05)。除1例经关节突入路术中减压时出口根损伤外,术中、术后无其它严重并发症发生。末次随访时间>6个月者共8例,其中7例(87.5%)骨性融合。结论脊柱内镜辅助下腰椎椎体间融合术治疗L_(5)-S_(1)峡部裂性滑脱是一种微创、安全、有效的术式选择。Objective To report the technical note and preliminary results of full endoscopic lumbar interbody fusion for the treatment of L_(5)-S_(1) isthmic spondylolisthesis.Methods From May 2019 to October 2021,10 patients with L_(5)-S_(1) isthmic spondylolisthesis were treated with full endoscopic lumbar interbody fusion,including 6 males and 4 females.The mean age was (57.8±10.4) years old (range:40-79 years).There were 6 cases with grade1 and 4 with grade 2 spondylolisthesis according to Meyerding grade system,while 2 of them were identified as nearly grade 3 slip.One of them was diagnosed as two-level grade 2 isthmic spondylolisthesis,and were treated by two-level endoscopic fusion.L_(4-5) spinal canal stenosis accompanied in 2 cases was treated by endoscopic decompression alone simultaneously.The surgical procedure was performed on 4 cases via transforaminal approach,and on6 cases via trans-facet joint approach,respectively.The decompression and implant were evaluated by X ray and CT postoperatively.The clinical result was evaluated by Oswestry Disability Index (ODI),Visual Analogue Scale for back pain and leg pain (VAS),and Japanese Orthopaedic Association (JOA) scale before surgery,after surgery and at the final follow-up,respectively.Results All patients underwent endoscopic lumbar interbody fusion,without conversion to open surgery.The average operation time was (297.2±87.2) minutes.Length of hospital stay was(16.0±4.3) days averagely,(9.4±3.8) days of which was postoperative hospital stay.The follow-up time was(17.1±10.3) months (range:3-30 months).The ODI scores,VAS back,VAS leg and JOA score were significantly improved postoperatively and at the final follow-up (P < 0.05).Statistically significant differences were found in terms of slip distance,slip rate and intervertebral height (P < 0.05).The segmental angle was significantly increased after surgery (P < 0.05).Exiting nerve root injury occurred during decompression via trans-facet joint approach in 1 case.No other severe complications occurred during

关 键 词：内窥镜 最小侵入性外科手术 脊柱融合术 腰椎 脊椎滑脱 

分 类 号：R687.3[医药卫生—骨科学]