后路内窥镜下髓核摘除术联合椎间融合固定治疗腰椎退变失稳性椎间盘突出症

Posterior endoscopic discectomy combined with lumbar interbody fusion in the treatment of lumbar intervertebral disc protrusion with degenerative lumbar spinal instability

目的探讨后路内窥镜下髓核摘除术联合可膨胀脊柱融合器（B-Twin）椎间融合治疗腰椎退变失稳性椎间盘突出症的疗效。方法选择2007年11月~2009年11月我院收治的退行性腰椎间盘突出症合并腰椎失稳患者22例,均采用后路内窥镜下髓核摘除术联合B-Twin椎间融合治疗。术前、术后1周及末次随访时应用JOA评分进行评价,并计算改善率,复查时X线片和CT观察椎间融合及椎间隙高度变化情况。结果 22例患者均顺利完成手术,手术时间为70~110 min,平均83 min;出血量为200~400 mL,平均280 mL;术后随访16~40个月,平均34.3个月。术前JOA评分平均14.8分,末次随访时JOA评分平均27.6分,改善率达75%~100%。复查X线片、CT示椎间高度丢失率为18%（4/22）,椎间隙植骨融合率为86%（19/22）,无感染、血肿、神经损伤及融合器脱落等并发症。结论采用后路内窥镜下髓核摘除联合B-Twin椎间融合治疗腰椎退变失稳性椎间盘突出症创伤较小,出血量少,近期随访疗效满意。

Objective To discuss the clinical efficacy of posterior endoscopic discectomy combined with expandable spinal spacer（B-Twin） lumbar interbody fusion in the treatment of lumbar intervertebral disc protrusion with degenerative lumbar spinal instability.Methods 22 patients with lumbar intervertebral disc protrusion and degenerative lumbar spinal instability in our hospital from November 2007 to November 2009 were selected.All the patients were treated with posterior endoscopic discectomy combine with B-Twin lumbar interbody fusion.JOA score was used to evaluation before operation,one week after operation and the last follow-up,recovery rate was calculated.Conditions of interbody fusion and disc height height change were observed by X-line and CT during reexamination.Results All 22 patients were smoothly finished operation.The operation time was 70-110 min,average of 83 min;amount of bleeding was 200-400 mL,average of 280 mL.All the patients were followed up for 16-40 months,average of 34.3 months.Average JOA score of before operation was 14.8 scores,which of the last time follow-up was 27.6 scores,the improvement rate was 75%-100%.The reexamination of X-line and CT showed that the height of intervertebral lost rate was 18%（4/22） and the lumbar interbody fusion rate is 86%（19/22）.There was no complication,such as infection,hematoma,nerve injury,B-twin falling off.Conclusion Application of posterior endoscopic discectomy combined with B-Twin lumbar interbody fusion in the treatment of lumbar intervertebral disc protrusion with degenerative lumbar spinal instability has little trauma and bleeding,and the recent follow-up results are satisfactory.