肌间隙入路单侧钉棒内固定加椎间融合治疗腰椎间盘突出伴不稳

Treating the lumbar disc herniation merger lumbar instability with half screw-stick fixing device and intervertebral fusion through the Wiltse approach

目的探讨采用手术新入路利用单侧钉棒内固定加椎间融合治疗腰椎间盘突出伴不稳的综合疗效。方法 25例腰椎间盘突出伴不稳患者采用肌间隙入路,保护脊柱后方韧带复合体,利用TLIF术式辅助单侧钉棒固定及椎间融合治疗。分别于术前、术后对患者的腰腿痛情况进行VAS评分,同时评价术后腰椎融合率。结果 25例患者术后功能明显恢复正常,腰腿痛症状基本消失,1例残留轻度腰痛症状,经对症治疗后缓解,腰椎融合率100%。结论具有单侧神经根症状的腰椎间盘突出伴不稳患者,采用肌间隙入路并进行单侧钉棒固定及融合,术中保留了后方韧带复合体,显露充分,出血少,创伤小,侧隐窝减压彻底,临床效果好,值得临床推广应用。

Objective To explore the comprehensive effect of adopting new operative approach using unilateral screw-stick fixation and interbody fusion in the treatment of lumbar disc herniation merger lumbar instability. Methods 25 cases of lumbar disc herniation merger lumbar instability were treated with TLIF assisted with the Wiltse approach and protection spinal posterior ligamen-tous complex. The patients with low back and leg pain VAS score were measured at preoperation and postoperation. Meanwhile,the postoperative lumbar fusion rate was evaluated. Results The postoperative function of 25 patients obviously relieved to normal, low back and leg pain symptoms disappeared.1 case remained mild back pain,and symptoms were relieved by symptomatic treatment. The fusion rate was 100%. Conclusion The patients with intervertebral disc herniation merger lumbar instability with unilateral nerve root symptoms obtained the better clinical effect and worthy of clinical application,through the Wiltse approach with unilateral screw-stick fixation and interbody fusion. Meanwhile,intraoperation it can remain the posterior ligament complex,and maintain good exposure,less bleeding,less trauma, lateral recess thorough decompression.