摘要
目的评价椎旁肌间隙入路选择性治疗部分腰椎退行性病变的可行性，并与传统后正中入路相比较。方法50例患者随机分为两组，一组采用脊柱后正中入路（后正中入路组），另一组采用椎旁肌间隙入路（肌间隙入路组）。均行腰椎管减压；对需要行内固定者置入椎弓根钉棒系统，对有腰椎滑脱或侧凸者进行复位，对腰椎不稳定者行椎间植骨融合。对两组病例的术中出血量、手术前后的疼痛视觉模拟评分（VAS）、手术前后的Oswestry功能障碍指数（ODI）等进行比较。结果所有病例均获得术后1年以上的随访，腰腿痛症状均获明显改善，有腰椎滑脱或侧凸者获得良好纠正，行腰椎间融合者术后1年均出现融合。与后正中入路组相比较，肌间隙入路组减少术中出血量，降低术后VAS评分和Oswestry功能障碍指数；明显优于后正中入路组。结论选择性应用椎旁肌间隙入路治疗部分腰椎退行性病变是可行的；能够尽可能地保留脊柱原始解剖结构，在减少创伤的同时，同样可行复位、固定和椎间融合，值得临床应用。
Objective To assess the feasibility of the selective transmuscnlar paraspinal approach （TPA） for partial lumbar degenerative disease and to compare it with the traditional approach. Methods Fifty patients were divided randomly into two groups. Patients in control group received surgical treatment of spinal posterior approach, and those in experimental group received TPA surgery. Lumbar spinal canal decompression was performed in both groups ; pedicle screw rod system was implemented for those who needed internal fixation, reduction for spondylolisthesis or scoliosis, and interbody fusion for lumbar spinal instability. The intraoperative blood loss, visual analogue scale （VAS） score and Oswestry disability index （ODI） in the two groups were analyzed. Results Patients included in this study were all followed up for more than 1 year. Surgical treatment significantly relieved the low back pain in patients; Spondylolisthesis and scoliosis were well reduced; Fusion occurred 1 year after surgery in alls patients undergoing interbody fusion. The intraoperative blood loss, VAS and OD! after surgery of TPA group were significantly better than those of the control group. Conclusion Compared with the traditional approach, TPA is a better therapy choice for certain partial lumbar degenerative disease. It can not only facilitate the surgical treatment, such as decompression,reduction, fixation and inter body fusion, but also restore the original structure of spines and reduce iatrogenic trauma more effectively.
出处
《临床外科杂志》
2012年第3期189-191,共3页
Journal of Clinical Surgery
