经肌间隙和椎间孔入路减压植骨融合单侧固定治疗椎管容积狭小腰椎间盘突出症的疗效观察  

Efficacy of transmuscular and transforaminal approach decompression and bone grafting fusion with unilateral fixation for lumbar disc herniation with spinal stenosis

作　　者：李忠伟 周坤 杨新明 银乐乐 徐翔 张树文 崔泳[1] LI Zhongwei;ZHOU Kun;YANG Xinming;YIN Lele;XU Xiang;ZHANG Shuwen;CUI Yong(Department of Spine Surgery,Xinjiang Medical University Fifth Affiliated Hospital,Urumqi,Xinjiang 830000,China;不详)

机构地区：[1]新疆医科大学第五附属医院脊柱外科,新疆乌鲁木齐830000 [2]新疆维吾尔自治区人民医院骨科中心脊柱外科,新疆乌鲁木齐830000

出　　处：《中国骨与关节损伤杂志》2025年第3期258-261,共4页Chinese Journal of Bone and Joint Injury

摘　　要：目的观察经肌间隙和椎间孔入路减压植骨融合单侧椎弓根钉内固定治疗椎管容积狭小腰椎间盘突出症的可行性及临床疗效。方法回顾性分析自2019-01—2020-06手术治疗的54例椎管容积狭小腰椎间盘突出症,观察组27例经肌间隙和椎间孔入路减压植骨融合单侧椎弓根钉内固定,对照组27例经后正中入路全椎板切除减压植骨融合双侧椎弓根钉内固定。比较两组手术时间、术中出血量、术后2周疼痛VAS评分、术后6个月ODI指数、椎间植骨融合时间。结果54例均获得随访,随访时间9~16个月,平均11.3个月。术中均无神经、血管损伤,观察组1例脑脊液漏,对照组2例脑脊液漏,对症处理。术前责任节段支配肌群肌力为Ⅰ、Ⅱ级的患者肌力恢复至Ⅲ级,其余患者均恢复至正常。观察组手术时间较对照组短,术中出血量少于对照组,术后2周疼痛VAS评分低于对照组,术后6个月ODI指数低于对照组,差异有统计学意义(P<0.05)。观察组椎间植骨融合时间为(12.00±1.14)个月,对照组为(11.07±1.28)个月,组间椎间植骨融合时间差异无统计学意义(P>0.05)。结论经肌间隙和椎间孔入路减压植骨融合单侧椎弓根钉内固定治疗椎管容积狭小的腰椎间盘突出症可以取得满意的疗效,具有手术操作简单、创伤小、安全性较高、并发症少等优点。Objective To observe the feasibility and clinical efficacy of transmuscular and transforaminal approach decompression and bone grafting fusion with unilateral pedicle screw internal fixation for lumbar disc herniation with spinal stenosis.Methods Fifty-four patients with lumbar disc herniation with spinal stenosis treated by surgery from January 2019 to June2020 were retrospectively analyzed.Twenty-seven patients in the observation group were treated with intramuscular space and foraminal approach decompression and bone grafting combined with unilateral pedicle screws internal fixation.Twenty-seven patients in the control group were treated with posterior approach complete laminectomy decompression bone grafting and bilateral pedicle nail internal fixation.The operation time,intraoperative bleeding,VAS scores at 2 weeks postoperatively,ODI indices at 6 months postoperatively,and intervertebral implant fusion time were compared between the two groups.Results Fiftyfour cases were followed up for 9 to 16 months,with a mean of 11.3 months.There were no intraoperative neurological or vascular injury in any of the patients.One patient of cerebrospinal fluid leakage in the observation group and two cases of cerebrospinal fluid leakage in the control group were treated symptomatically.The muscle strength of the innervated muscle group of the responsible segment was gradeⅠandⅡbefore the operation,and the muscle strength of the patients was restored to gradeⅢ,and the rest of the patients were restored to normal.The operation time of the observation group was shorter than that of the control group,the intraoperative bleeding was less than that of the control group,the pain VAS score was lower than that of the control group at 2 weeks after operation,and the ODI index was lower than that of the control group at 6 months after operation,and the difference was statistically significant(P<0.05).The time of intervertebral implant fusion was(12.00±1.14)months in the observation group and(11.07±1.28)months in the control g

关 键 词：腰椎间盘突出症 椎管容积狭小 肌间隙入路 椎间孔入路 植骨融合 椎弓根钉 单边内固定 

分 类 号：R681.5[医药卫生—骨科学]