通道辅助下多节段腰椎管狭窄症的微创治疗

Minimally Invasive Surgery for Multilevel Degenerative Lumbar Spine Stenosis with Tubular Retractor

目的探讨多节段腰椎管狭窄的微创治疗策略。方法2008年3月～2010年8月对34例多节段腰椎管狭窄，根据患者的临床表现、病理解剖及影像学表现采用3种微创手术方式，按手术方式分为3组：A组12例采用双侧减压同时进行椎间融合加双侧经皮内固定手术；B组11例采用单侧入路潜行双侧减压同时行椎间融合加单侧经皮内固定手术；c组11例采用扩张通道辅助单侧入路潜行多节段双侧减压术。评估术前、术后和末次随访时JOA评分和ODI，根据JOA、ODI改善率对手术疗效进行评价。结果34例手术均顺利完成。A、B、c组手术时间分别为（280±28）min，（220±31）min和（120±20）min；A、B、C组出血量分别为（290．5±20．9）ml，（270．7±18．7）ml和（120．3±22．6）ml。34例随访14．4～27．6月，平均19．2月。术后末次随访时3组JOA改善率分别为：A组（70±21）％，B组（73±17）％和c组（63±18）％；ODI改善率分别为A组（69±22）％，B组（71±19）％和c组（68±24）％；满意率3组分别为A组83．3％，B组81．8％和c组72．7％。结论微创手术是治疗多节段腰椎管狭窄症较为理想的手术方法，但手术方式的选择需要根据腰椎管狭窄症患者的临床症状、病理解剖、影像学表现及术者的临床经验和医院的条件来谨慎选择。

Objective To explore an ideal minimally invasive procedure for multilevel degenerative lumbar spine stenosis. Methods Retrospective study was carried out on 34 cases of lumbar spinal stenosis treated by minimally invasive surgery from March 2008 to August 2010. According to the clinical manifestations, pathological anatomy and imaging, three kinds of minimally invasive surgical procedures were performed. Patients were divided into three groups accordingly. Group A： 12 cases of bilateral decompression combined with bilateral percutaneous pcdicle screw fixation; group B： ll cases of unilateral approach for bilateral decompression combined with unilateral percutaneous pedicle screw fixation ; group C ： 11 cases of multi-segments bilateral decompression by unilateral approach. The lumbar function was evaluated by Oswestry disability index （ODI） , and the clinical results were assessed by Japanese Orthopaedic Association scores （JOA） pre- and postoperatively. Results All the 34 procedures were successful. The operative time of the 3 groups was （280±28） min （groupA）, （220±31） min （groupB） and （120±20） min （groupC）, respectively. The blood loss of the3 groups was （290.5 ±20.9） ml （group A）, （270.7 ± 18.7） ml （group B） and （120.3 ±22.6） ml （group C）, respectively. All the 34 cases were followed up for 14.4 to 27.6 months （mean, 19.2 months）. The improvement rates of JOA scores at the last follow-up of the 3 groups were as follows： group A （70 ±21）%, group B （73 ± 17）% and group C （63 ± 18）%, respectively; the improvement rates of ODI at the last follow-up of the 3 groups were as follows： group A （69 ± 22）% , group B （71 ± 19）% and group C （68 ± 24）%, respectively; the satisfaction rates of the 3 groups were as follows： group A 83.3%, group B 81.8% and group C 72.7% , respectively. Conclusion Minimally invasive surgery is an ideal procedure for multilevel degenerative lumbar spine stenosis, but the choice of specific procedure should be based on factors such as patients＇ clinical and pathological manifestations, clinical experience of surgeons and actual situation of hospitals.