经肌间隙入路单侧椎弓根固定在腰椎翻修术中的应用研究

Clinical effects of unilateral vertebral pedicle screw fixation from paraspinal muscle approach on lumbar revision surgery

目的:探讨经椎旁肌间隙入路单侧椎弓根固定结合改良椎间孔椎间融合术在腰椎翻修术中的临床疗效。方法:回顾性研究2008年3月-2010年5月我院采用上述方法治疗的26例腰椎翻修患者,收集分析手术切口长度、手术时间和术中出血量,对比分析翻修术前、末次随访时腰痛及腿痛VAS评分,临床疗效评估采用29分法(JOA)评分,并计算临床疗效改善率。结果:手术切口长度为(4.1±0.5)cm、手术时间为(119.3±25.8)min、术中出血量为(193.3±14.6)mL,腰痛VAS评分、腿痛VAS评分术前为(4.98±0.65)分和(7.21±0.34)分,末次随访为(0.90±0.69)分和(1.41±0.28)分,与术前比较差异均有统计学意义(P<0.05);JOA评分术前为(13.8±4.4)分,末次随访为(24.1±2.8)分,与术前比较差异有统计学意义(P<0.05)。结论:该法切口小,术中出血少,术后腰背痛缓解快,是腰椎翻修的一种可行方法。

Objective：To study the clinical effects of unilateral vertebral pedicle screw fixation from paraspinal muscle ap-proach plus modified transforaminal lumbar interbody fusion （TLIF） on lumbar revision surgery. Methods：Retrospective analysis of the datas of 26 patients who were undergone above surgery methods from March 2008 to May 2010 were done. Clinical outcomes were assessed by VAS score system and JOA score system. Results：The length of the surgical incision, operation time and intra-operative blood loss were（4.1＆#177;0.5）cm,（119.3＆#177;25.8）min and（193.3＆#177;14.6）mL respectively. Preop-erative VAS scores on pain of low back and leg were（4.98＆#177;0.65）score and（7.21＆#177;0.34）score,while those were（0.90＆#177;0.69） score and（1.41＆#177;0.28）score at final follow-up. Preoperative JOA score and JOA score of last follow-up were（13.8＆#177;4.4）score and（24.1＆#177;2.8）score. There were statistically significant differences between preoperative scores and scores of final follow-up （P＆lt;0.05）. Conclusions：Surgical method used in this experiment is reliable and effective for lumbar revision surgery with smaller surgical incision,less intra-operative blood loss.Pain of low back and leg was relieved quickly after operation.