通道肌间隙入路经椎弓根动态棒固定治疗腰椎退变性疾病效果观察  

Efficacy of transpedicle dynamic rod fixation via intramuscular approach in treatment of lumbar degenerative diseases

作　　者：王衡[1] 安博[1] 刘英杰[1] 冯金勇[1] 邵科武[1] 单朝[1] 郭新军 朱卉敏 WANG Heng;AN Bo;LIU Yingjie;FENG Jinyong;SHAO Kewu;SHAN Chao;GUO Xinjun;ZHU Huimin(Department of Spinal Surgery,Armed Police Corps Hospital of Henan Province,Zhengzhou 450052;The Center of Minimally Invasive Spinal Surgery,Zhengzhou Hospital,Henan Orthopaedic Hospital,Zhengzhou 450018)

机构地区：[1]武警河南总队医院脊柱外科,郑州450052 [2]河南省骨科医院郑州院区脊柱微创中心,郑州450018

出　　处：《郑州大学学报（医学版）》2023年第2期263-268,共6页Journal of Zhengzhou University(Medical Sciences)

摘　　要：目的:评估通道肌间隙入路(Wistle入路)经椎弓根动态棒固定手术(Dynesys)治疗腰椎退变性疾病的临床疗效。方法:回顾性分析2018年1月至2019年10月收治的腰椎退变性疾病患者36例,在全麻下通过微创通道Wistle入路完成神经减压及双侧Dynesys椎弓根螺钉置入(微创组);选取同期后正中入路神经减压辅助Dynesys手术的患者40例作为常规组。记录两组的手术时间、术中出血量、术后引流量;术前,术后第1、3、5天检测血清肌酸磷酸激酶(CPK)水平;术前、术后第5天、术后3个月、术后12个月、末次随访时记录腰腿痛视觉模拟评分(VAS);术前,术后3、6、12个月,末次随访时记录Oswestry功能障碍指数(ODI)、手术节段及上邻节段的活动度(ROM)以及手术节段的椎间隙高度(DH);记录末次随访时的MacNab优良率;记录围手术期及随访期间的并发症发生情况。结果:微创组术中出血量、术后引流量均小于常规组(P<0.05)。两组术后CPK水平先升高后降低,微创组升高幅度小于常规组(P<0.05);两组术后腰腿痛VAS均降低,微创组腰痛VAS降低幅度大于常规组(P<0.05);两组术后ODI、手术节段ROM均逐渐减小,上邻节段ROM逐渐增大,DH先增加后降低;微创组上邻节段ROM小于常规组(P<0.05)。两组MacNab优良率、围手术期及随访期间并发症发生率比较,差异无统计学意义(P>0.05)。结论:Wistle入路Dynesys手术治疗腰椎退变性疾病的疗效令人满意,优于后正中入路。Aim:To evaluate the clinical efficacy of transpedicle dynamic rod fixation(Dynesys)through intermuscular approach(Wistle approach)in the treatment of lumbar degenerative diseases.Methods:A retrospective study was conducted on 36 patients with lumbar degenerative diseases from January 2018 to October 2019.They were classified as the minimally invasive group(M-group)and were treated by Dynesys implantation and decompression through Wistle approach with the minimally invasive Quadrant retractor under general anesthesia.Another 40 patients who underwent conventional Dynesys implantation and decompression through the posterior median approach during the same period were selected as the conventional group(C-group).The operation time,intraoperative blood loss,and the postoperative drainage volume were recorded.The serum creatine phosphokinase(CPK)levels of patients were detected preoperatively,1 day,3 days and 5 days postoperatively.The visual analogue scale(VAS)of the back and leg pain were recorded preoperatively,5 days,3 months,12 months postoperatively,and at the last follow-up.The Oswestry disability index(ODI)and the disc height(DH),as well as the range of motion(ROM)of the operative segment and the upper adjacent segment were calculated preoperatively,3 months,6 months,12 months postoperatively,and at the last follow-up.The modified MacNab criteria was recorded at the last follow-up.The complications during the perioperative and follow-up period were recorded.Results:The intraoperative blood loss and postoperative drainage in M-group were significantly less than those in C-group(P<0.05).The postoperative CPK levels in the two groups increased first and then decreased,and the postoperative CPK elevation was smaller in M-group than that in C-group(P<0.05).The back and leg VAS gradually decreased in both groups after surgery,and the reduction of postoperative back VAS was greater in M-group than that in C-group(P<0.05).The ODI and the ROM of the operative segment gradually decreased in both groups after surgery.The

关 键 词：腰椎退变性疾病 肌间隙入路 经椎弓根动态棒固定 DYNESYS 

分 类 号：R687.32[医药卫生—骨科学]