内窥镜下单神经孔人路腰椎减压、植骨融合内固定术42例近期临床结果

Endoscopic transforminal lumbar decompression,interboy fusion and pedicle screw fixation under X-tube system,report of 42 cases

目的探讨内窥镜(METRx)下经 X-Tube 单侧神经孔入路行椎间盘摘除、椎间植骨融合的疗效。方法对2004年6月至2006年3月完成的42例内窥镜(METRx)下经 X-Tube 单侧神经孔入路行椎间盘摘除、椎间植骨融合的近期疗效进行总结分析。42例患者中,男17例,女25例,平均年龄51.6岁。均为腰椎间盘突出伴腰椎不稳和腰椎弓根峡部嵌裂伴滑脱的患者。结果平均手术时间240 min;平均出血量140 ml;平均手术切口长度3 cm;术后平均住院时间12.5 d;按照 Nakai分级,优23例(62.2%),良11例(29.2%),可3例(8.6%)。椎间植骨融合率91.9%。5例患者(11.9%)发生并发症。结论内窥镜(METRx)下经 X-Tube 单侧神经孔入路行椎间盘摘除术具有手术切口小、腰骶肌肉剥离轻、出血少、术后手术伤口疼痛较轻等优点,是临床上可供选择的一种微创新术式。

Objective To evaluate the surgical procedure of unilateral transforminal discectomy, bone gaffing, cage （Telamon） insertion and Dylanok pedicle screw fixation using X-tube operation system for the treatment of lumbar disc herniation combined with segmental instability and spondylolithesis with pars defect. Methods From 2004 to 2006, 42 patients including 17 male and 25 female were treated in our department. The age range from 22 to 77 （mean. 51.6）. Etiologies including lumbar disc herniation combined with segmental instability and spondylolithesis with pars defect. Result Of these 42 patients, the mean operation time was 240 min （110-320 min）, the average blood loss was 140 ml （80-420 ml）, the average incision length was 3cm （2. 8-3, 2 cm） and the average hospitalization time was 12, 5 days （5-25 days）. Nakai criteria, Excellent in 23 cases（62. 2% ）, good in 11 cases （29. 2% ） and fair in 3 cases （8.6%）. 5 patients had postoperative complication （complication rate： 16. 3% ）, Conclusions The surgical procedure has shown predominant benefits： small incision, less stripping of paraspinal muscles, minimal blood loss and rapid postoperative recovery which makes it a valuable alternative to conventional surgical procedures.