椎间盘镜下单侧椎弓根钉结合对侧椎板关节突螺钉内固定治疗下腰椎退行性疾病

Therapeutic effects of unilateral pedicle screw combined with contralateral translaminar facet screw fixation under endoscope to treat lower lumbar degenerative diseases

目的探讨应用椎间盘镜及可扩张管微创系统（Quadrant系统）辅助下单侧椎弓根钉固定及cage椎间融合术结合对侧椎板关节突螺钉内固定治疗下腰椎退行性疾病的可行性和疗效。方法自2010年1月～2012年1月采用微创通道下经椎问孔融合器植骨单侧椎弓根钉固定，并在椎间盘镜通道辅助直视下行对侧椎板关节突螺钉内固定治疗32例下腰椎退行性疾病。结果本组获随访12～32个月，平均22．4个月。术后和随访期间腰痛和腿痛视觉模拟评分与Oswestty功能障碍指数评分与术前相比均明显改善。差异有统计学意义（P〈0．01）。按照Nakai分级：优22例，良8例，可2例。所有患者元螺钉松动、断裂及cage移位等并发症。结论椎间盘镜及Quadrant系统辅助下单侧椎弓根钉结合对侧椎板关节突螺钉内固定的方法具有操作简单、创伤出血少、稳定可靠、X线暴露少、学习曲线短等优点，是部分下腰椎病变固定融合的可选方法。

Objective To investigate the feasibility and efficiency of unilateral pedicle screw combined with contralatendtranslaminar facet screw under Mast Quadrant and endoscope to treat lower lumbar degenerative disease. Methods From January 2010 to January 2012,32 patients with single-level lumbar disc disease were treated with minimally invasivetransforamivtal lumbar interbody fusion,unilateral pedicle screw combined with contralateral tranglamirmr facet screw under Mast Quadrant and endoscope. Results All patients were followed up for 12～32 months （average 22.4 months）.During thefollow-up the visual analogue scale and Oswestry disability index scores were significant improved compared with preoperative （P 〈0.01）. With Nakai criteria,excellent result was in 22 cases,good in 8 cases and fair in 2 cases, with no recurrence of instrumentation failure at follow-up. Conclusion Unilateral pedicle screw combined with contralateral translamlvlar facetscrew in transforaminal lumbar interbody fusion under Mast Quadrant and endoscope is safe and efficient, with advantages such as simple procedure, little traurna forceful fixation, less X-my exposure,short learning curve, and so on. Therefore, it is valuable alternative choice for partial lower lumbar degenerative diseases.