Mini-Spine牵开器在椎旁肌间隙入路腰椎融合术中应用的初步研究

Preliminary study for the application of the Mini-Spine retractor in the paravertebral muscle space approach of lumbar fusion

目的探讨Mini-Spine牵开器在椎旁肌间隙入路腰椎融合术中的应用。方法 2008-06-2008-12间,采用Mini-Spine牵开器治疗腰椎间盘突出患者13例,男8例,女5例,平均年龄47岁。病变均为单节段,其中L4-5椎间盘突出并腰椎不稳症4例,L4-5椎间盘突出并单侧侧方型椎管狭窄症3例,L5-S1极外侧椎间盘突出症1例,L5-S1椎间盘突出并腰椎不稳症3例,L5-S1椎间盘突出并单侧侧方型椎管狭窄症2例。术前患者主要症状表现为腰痛伴一侧下肢放射性疼痛。其中1例极外侧椎间盘突出症患者行微创TLIF术,其余12例患者均行微创PLIF手术。结果患者手术时间为90~150 min,平均104 min,出血量50~200 ml,平均122 ml。患者术后症状均得到明显缓解。术后第1天腰痛VAS评分1~3分,平均1.7分;术后第2天腰痛VAS评分1~3分,平均1.5分,术后均未服用止痛药物。术后3~6 d下地活动,平均4.1 d,住院时间5~9 d,平均6.3 d。结论应用Mini-Spine牵开器进行椎旁肌间隙入路的腰椎融合术具有创伤小、患者术后疼痛轻、恢复快的优点,在治疗腰椎疾病时具有一定的优势。

Objective To evaluate the efficacy of the application for Mini-Spine retractor in the paravertebral muscle space approach of lumbar fusion.Methods From June 2008 to December 2008,13 cases with lumbar disc herniation underwent the Mine-Spine retractor were reviewed.There were 8 males and 5 females,with a mean age of 47 years.Lesions were single segment.There were 4 cases of L4-5 disc herniation and lumbar instability,3 cases with L4-5 disc herniation and unilateral lateral spinal stenosis,1 case with L5-S1 extreme lateral disc herniation,3 cases L5-S1 disc herniation and lumbar instability,2 cases L5-S1 disc herniation and unilateral lateral spinal stenosis.The main preoperative symptoms of patients were low back pain with radiation of lower extremity pain in one side.The patient who was extreme lateral disc herniation underwent minimally invasive TLIF technique,and the remaining 12 patients underwent minimally invasive PLIF surgery.Results Operative time ranged from 90~150 minutes,averaging 104 minutes.Blood loss was 50~200 ml,an average of 122 ml.Patients＇ symptoms had been significantly reduced.VAS score of low back pain ranged 1~3 points（with an average of 1.7 points）in the first day after surgery,and the VAS score of low back pain in the second day after surgery were 1-3 points with an average of 1.5 points,postoperative analgesic drugs were not used.Inambulation were 3-6 days（an average of 4.1 days）postoperatively.The hospital stay were 5~9 days with an average of 6.3 days.Conclusion The application for Mini-Spine retractor in the paravertebral muscle space approach of lumbar fusion has advantages of less trauma,reduced postoperative pain and quick restoration in patients.