腹腔镜微创技术在腰椎滑脱症前路椎间融合术中的应用

TREATMENT FOR LUMBAR SPINE SPONDYLOLISTHESIS BY LAPAROSCOPIC ANTERIOR FUSION

目的 :评价腹腔镜微创技术在腰椎滑脱症前路椎间融合术中的应用。方法 :回顾性分析应用腹腔镜治疗的 15例腰椎滑脱症患者 ,所有病人均行后路减压复位 ,前路腹腔镜下BAK植骨融合术。结果 :腹腔镜组平均出血量 411ml(2 41～ 6 80 ) ,平均手术时间 35 5min(2 6 0～ 44 5 ) ,平均伤口引流 130ml(5 0～ 2 10 ) ,平均住院时间11d(7～ 15 ) ,与后路组 (对照组 )进行t检验 ,平均出血量与住院时间具有统计学意义 ,P <0 .0 5。 15例腹腔镜组患者中术后随访 3月～ 2年 (平均 10 .2月 ) ,14例术后症状完全消失 ,Ⅰ°滑脱 6例完全复位 ,Ⅱ°4例复位 ,Ⅲ°2例复位 ,除 1例并发全身纵隔皮下气肿外 ,无感染及神经系统并发症。结论 :腹腔镜微创技术在腰椎滑脱症前路椎间融合术中的应用是有效的 。

Objective:To evalue the efficacy and safety for the treatment of lumbar verterbrae spondylolisthesis combined with the technique of laparoscopic anterior lumbar interbody fusion with cage. Method:Retrospective analyze fifteen patients,From August 1998 to February 2001,who were treated by posterior decompersire laminectomy and pedicle screw fixation,at the same time anterior interbody fusion with cage by laparoscopy.There were 5 males and 10 females,aged from 20 to 61 years old,with an average age of 44.3 years.7cases were classified as degree 1,6 cases degree 2,2cases degree 2,selecting fifteen cases of lumbar spondylolistheisis treated by PLIF compared with laparoscopic surgery,paired-T test,analysis.Results: By laparoscopic technique,there was an average bleeding 411ml (242～680),average operative time 355min (260～445),average incision drainage volume 130ml(60～210),average hospital stay 11d (7～15),the T-value of average bleeding 3.760,P<0.05,T-value of average hospital stay .431,P<0.05,there were important clinical meaning.The patients were followed up from 3 to 24 months,with an average of 10.2 months,the pre-operative clinical symptoms disappeared completely in 14 of 15 cases,6 of 7 cases with dgree 1,4 of degree 2,2of dergree 3 completely in 14 of 15 cases,6 of 7 cases with degree 1,4 of degree 2, 2 of degree 3 spondy-lolistheisis obtained complaete reduction of the olisthly vertebral bodies,No infection or neurologic complication occurred in this series,One patient suffered mediastinal sand skin emphysema.Conclusions:Minimally invasive laparoscopic spine surgery in the treatment of lumbar spondy lolisthesis is effective and safe.