应用Viper和Pipeline微创系统治疗腰椎退行性疾病

Treatment of lumbar degenerative diseases using Viper and Pipeline minimal invasion system: a clinical analysis

[目的]探讨Pipeline通道下腰椎管减压、椎间盘切除、椎间融合、Viper经皮椎弓根钉固定治疗腰椎退变性疾病的临床效果。[方法]2009年1月～2011年1月收治腰椎退变性疾病患者44例，男26例，女18例；年龄52—84岁，平均66．7岁。均采用Pipeline通道下腰椎管减压、椎间盘切除、椎间融合、Viper经皮椎弓根钉固治疗，随访观察治疗效果。[结果]手术时间90～270min，平均131．1min；术中失血量50—300ml，平均125．9ml，所有患者手术切口均一期愈合，平均住院时间9．5d（7～18d）。1例术后早期出现剧烈腰痛（2．3％），1例发生椎间融合器移位（2．3％）。术前腰痛VAS评分（7．62±0．44）分，术后（3．51±0．82）分；术前腿痛VAS评分（8．13±0．61）分，术后（3．12±0．36）分；术前ODI指数（80．26±5．09），术后（28．77±2．53）。44例患者最少获得24个月随访，42例患者椎间骨性融合，2例椎间部分骨性融合。根据Nakai分级，优39例（88．6％），良3例（6．8％），可2例（4．6％）。[结论]Pipeline通道下腰椎管减压、椎间盘切除、椎问融合、Viper经皮椎弓根钉固定治疗腰椎管狭窄症等腰椎退变性疾病具有手术切口小、软组织剥离范围小、术中失血少、术后恢复快、临床疗效好等优点，但其手术时间相对较长，手术操作难度较大，需要特殊设备和工具，且术中医患所受辐射量较多。

[ Objective] To evaluate the clinical effect of surgical treatment with spinal canal decompression, autograft and cage implantation for interbody fusion using Pipeline operation system, and percutaneous pedicle screw fixation using Viper sys- tem in patients with lumbar degenerative diseases. [ Methods] Forty -four patients including 26 male and 18 female were trea- ted in our department from Jan 2009 to Jan 2011. The mean age was 66. 7 years （52 ~ 84 years old） . The diagnosis of lumbar degenerative diseases was affirmed by X - ray, CT and MRI, as well as clinical symptoms. All the patients underwent spinal ca- nal decompression, discectomy, autograft and cage implantation for interbody fusion using Pipeline operation system and percuta- neous pedicle screw fixation using Viper operation system. Clinical outcome were observed by follow - up. [ Results] The aver- age operation time was 131.1 rain （range, 90-270 min）, the average blood loss was 125.9ml （range, 50 -300ml） and the average hospitalization time was 9.5 days （range, 7 - 18 days） . One - stage incision healing was achieved in all patients. Complications were found in 1 case （2.3%） with early postoperative severe low baek pain and 1 case （2.3%） with interbody displaeement. The mean VAS score was （7.62±0. 44 ） preoperativey while （3.51± 0. 82 ） postoperativey in low back pain. The mean VAS score was （8.13±0. 61 ） preoperatively while （3.12 -＋ 0. 36） postoperatively in leg pain. The ODI was （80. 26±5.09 ） preoperatively while （28.77±2. 53 ） postoperatively. Forty -four cases were followed -up for at least 24 months （av- erage 33.8 months） , 42 eases got bony fusion, and partly bony fusion was found in 2 cases. According to the Nakai criteria, the clinical effect was excellent in 39 eases （88.6%） , good in 3 cases （6.8%） and fair in 2 eases （4.6%） .[ Conclusion] Despite the surgical procedure have some disadvantages such as relatively long operation time, more difficult, requiring special equipment, and more radiation to doctors and patients intraoperativly, it still has shown predominant benefits： small incision, less stripping of paraspinal muscles, minimal blood loss and rapid postoperative recovery. All these make it a valuable alternative to conventional surgical procedures.