微创腰椎360°固定术

360°fixation of lumbar spine

目的评估微创腰椎360°固定术的疗效。方法从2002年5月至2005年5月，应用微创腰椎360。固定术治疗患者25例，其中男11例，女14例；年龄45～67岁，平均56岁。腰椎滑脱16例，其中Ⅰ度13例、Ⅱ度3例；腰椎不稳7例；椎间盘源性腰痛2例。行L4，5节段融合14例，L5-L1，11例。功能评估采用Oswestry Disability Index（ODI），统计患者术前、术后2周、3、6、12个月的ODI评分。术后即刻、3、6、12个月摄X线片，观察椎体的融合情况和融合器（cage）有无下沉。结果手术时间从110～180min。术中发生1例下腔静脉破裂出血。术后全部病例获得随访，随访时间12～35个月，平均22．3个月。ODI评分手术前为34．15±5．17，术后2周为43．27±10．43，术后3个月为46．14±6．85，术后6个月为44．97±3．65，术后12个月为46．38±4．48，与术前相比有显著差异（P〈0．05）。25例植骨手术后3个月融合。1例患者术后3个月X线片显示相邻椎体滑移2mm，6个月时融合。2例患者发生椎间高度丢失1mm。无一例发生内置物松动、滑落及逆向射精等并发症。结论微创腰椎360°固定术适用于腰椎不稳、局限节段椎间盘变性及Ⅱ度以下腰椎滑脱伴神经根管狭窄患者。手术出血少、损伤小，但操作时应特别注意大血管的暴露和牵开。

Objective To estimate the effects of the treatment of 360°fixation of lumbar spine. Methods Twenty-five cases were operated to 360° fixation of lumbar spine from May 2002 to May 2005. There were 11 male and 14 female, the age ranging from 45 to 67 years, mean 56, including 16 cases of spondylolithesis, 7 cases of lumbar spinal instability and 2 cases of degenerative disc undergone with anterior laperascopic lumbar interbody fusion with syncage and autograft and posterior decompression with facet fixation. The chief complains were low back pain and radiating to lag. Fourteen cases were fused at L4.5 and 11 cases at L5 -S1-The Oswestry Disability Index （ODI） were recorded to evaluate the function at prooperation, the second week, the third, sixth and twelfth month post-operation. The X-ray was taken to observe the fusion and the sinking cage. Results The time intro-operation was from 110 to 180 minutes, mean 120 minutes. There was one complication in 1 case by the main vein injury. All of the 25 cases were followed-up post-operation from 12 to 35 months, mean 22. 3 months. The ODI was found prominent difference compared with pro-operation in 2 weeks, 3, 6 and 12 months post-operation（ P 〈 0. 05 ）. Twentyfive cases were fused in the third month. Two cases sank 1 mm in the third month images hut solid fusion. No cage displacement was found. No retrograde ejaculation happened. Conclusions 360° fixation of lumbar spine adapts to deal with lumbar instability, degenerative disc disease and Ⅰ ,Ⅱ degree spondylolithesis. It shows less bleeding and injury, but during exposure and traction the main vessels should be very careful.