经椎间孔外侧椎体间融合治疗腰椎退行性病变的临床研究

Clinical research of extraforaminal lumbar interbody fusion in the treatment of degenerative disorders of lumbar spine

[目的]评价经椎间孔外侧椎体间融合(ELIF)联合单侧椎弓根钉内固定治疗腰椎退行性病变的临床疗效。[方法]2008年11月~2010年12月治疗腰椎退行性疾病28例,均采用单侧经椎间孔外侧椎间融合联合单侧椎弓根钉内固定。应用视觉模拟评分系统(VAS)、Oswestry功能障碍指数评分系统(ODI)和SF-36评估患者术后疼痛及功能恢复情况,并对手术时间、出血量、融合率及并发症发生率等进行统计分析。[结果]所有患者获得随访,平均随访时间为16.3个月(12~22个月)。手术时间为(88.3±26.4)min,术中出血量为(122.4±30.2)ml;腰腿痛VAS评分分别由术前的(7.6±1.2)分降至末次随访时的(2.7±0.6)分;ODI评分从术前的(42.2±11.8)分降至末次随访时的(15.6±2.3)分;SF-36PF术前为(30.64±5.04),末次随访时升至(48.55±6.12);SF-36BP术前为(28.91±5.03),最后随访时为(51.73±11.05);融合率为96.4%(27/28)。VAS评分、ODI评分、SF-36PF、SF-36BP术前与末次随访比较差异有显著性意义(P<0.05)。[结论]ELIF手术技术具有切口小、出血少,不破坏正常结构,手术时间短,功能恢复满意的优点,是治疗腰椎退行性疾病非常有效的方法之一,但应严格掌握适应证。

[Objective] To explore the clinical result of extraforaminal lumbar interbody fusion with unilateral pedicle screw fixation for the treatment of lumbar degenerative diseases.[Methods] From November 2008 to December 2010,28 patients with lumbar degenerative diseases were treated with extraforaminal lumbar interbody fusion with unilateral pedicle screw fixation.VAS score,ODI score system and SF-36 were used to evaluate the preoperative and postoperative pain and function recovery.Operative time,volume of blood loss,fusion rate and complication rate were analyzed by statistical test.[Results] No patient had iatrogenic spinal cord injury or other complications.All the cases had been followed up from 12 to 22 months(mean16.3 months).Operative time and volume of blood loss were(88.3±26.4) min and(122.4±30.2) ml,respectively.VAS score,ODI score,SF- 36PF and SF- 36BP decreased respectively from preoperative 7.6±1.2,42.2±11.8,30.64±5.04,28.91±5.03 to 2.7±0.6,15.6±2.3,48.55±6.12,51.73±11.05 at the last follow- up.The fusion rate was 96.4%(27/28).[Conclusion] ELIF has the advantages of small incision,little bleeding,no destruction of the structure,short operating time,low medical device expenses and good recovery.And it is one of effective surgical treatments for degenerative disorders of lumber spine.But the operation indications must be strictly defined.