开窗式腰椎椎体间融合术的临床观察

Clinical observation of fenestration of lower lumbar interbody fusion technique

目的:总结开窗式椎体间融合术的手术方法,评价其在治疗退行性腰椎病变的应用效果。方法:采用后路椎板间开窗式入路,牵开神经根及硬膜囊显露椎间盘,在其后部开孔切除髓核及内侧2/3纤维环,刮除软骨板,行椎体间Pyramesh钛网植骨融合,椎弓根螺钉内固定治疗下腰椎病变63例,其中腰椎间盘病变并腰椎不稳28例,腰椎滑脱19例,退变性腰椎不稳(含神经根管或侧隐窝狭窄)16例;男41例,女22例;年龄32～76岁,平均59岁。结果:术后随访3～26个月,平均15个月。依据北京大学第三医院的评分标准:优31例,良29例,可3例。无永久性神经损伤并发症发生。术后X线片显示植骨区骨密度随时间延长而加深,钛网融合器无下陷、移位,椎间高度无丢失,椎弓根螺钉系统无断裂和松动。结论:开窗式入路并椎体间钛网植骨融合术是一种操作简单、创伤小、并发症少的椎体间融合方式,应用时注意选择较小的融合器。

Objective：To summarize the method of interbody fusion through fenestration and evaluate its clinical result in the treatment of degenerative diseases of the lower lumbar spine. Methods ： Sixty-three patients with degenerative diseases of the lower lumbar spine underwent fenestration through inter-laminar space for lower lumbar interbody fusion with Pyramesh titanium cage and fixation with pedicular screw, The degenerative diseases included intervertebral disc disorder and lumbar instability（28 cases） ,lumbar spondylolisthesis（ 19 cases） ,degenerative lumbar instability（ 16 cases） ;41 male and 22 female with an average age of 59 years, Results： Postoperative follow-up was 3 -26 months with an average of 15 months in all the patients. According to evaluation standard of the 3rd Hospital of Beijing University, the outcome of operation was excellent in 31 cases,good in 29,fair in 3. No permanent nerve damage was found. The X-ray showed that the bone mineral density in the disc space increased gradually. No cage sinking,loss of the disc space, breakage or loosing of pedicular screw were found. Conclusion ：Fenestration through the inter-laminal space for lower lumbar interbody fusion is characterized by simple operation,less trauma,less complication and better clinical result. Minor fusion device could be first choosed during operation.