后正中小切口移动窗口技术在单节段腰椎椎体间融合术中的应用

Application of the Technique of "Mobile Skin and Soft Tissue Window" in Single Segment Lumbar Interbody Fusion

【目的】总结后正中小切口微创化椎间融合术治疗腰椎退行性疾病的手术操作技巧及短期临床疗效。【方法】2012年1月至2014年9月应用后正中小切口椎间融合术治疗单节段腰椎退行性疾病患者43例。C臂机透视定位病变节段,取后正中皮肤切口,采用＂移动皮肤及软组织窗口＂技术依次行置钉、减压及融合等手术步骤。统计患者术中出血量、手术时间、切口长度、术后引流量及手术相关并发症。于术后7 d、1个月、3个月、12个月进行随访,采用疼痛视觉模拟评分（VAS）和Oswestry功能障碍指数（ODI）对手术疗效进行评价。【结果】37例患者获得随访,随访时间13～25（15.2±4.7）月。术中出血量90～300 m L,平均（175.1±71.8）m L;手术时间103～150（129.0±12.0）min;皮肤切口长度5.1～6.0（5.4±0.3）cm;术后引流量80～240（116.5±66.0）m L。术后腰痛及腿痛VAS评分和ODI值均较术前下降,差异有统计学意义（P〈0.05）。腰痛及腿痛VAS评分术前平均为（6.6±0.8）及（7.0±0.1）分,术后12个月降至平均为（0.7±0.6）及（0.6±0.5）分,ODI值术前平均为68.6%±5.4%,术后12个月降至6.2%±1.6%。末次随访影像学检查符合椎间骨性融合标准,期间未发现内固定松动断裂。【结论】将微创治疗理念及＂移动皮肤及软组织窗口＂技术应用于传统后正中脊柱融合术,无需特殊器械即可获得良好直视视野,皮肤切口小、椎旁肌肉组织剥离及牵拉少、手术创伤小,术后功能康复快。治疗单节段腰椎退行性疾具有良好的临床疗效。

[ Objective ] To sum up the surgical techniques and short-term clinical effects of minimally invasive lumbar interbody fusion in the treatment of lumbar degenerative diseases. [ Methods ] 43 patients of lumbar degenerative disease who underwent minimally invasive posterior lumbar interbody fusion from January 2012 to September 2014 were retrospectively reviewed. The location of the lesion segment is located by C- arm fluoroscopy in the operation, then median incision was used. The working areas of placing pedicle screw, fusion, and decompression are well exposed by the technique of ＂mobile skin and soft tissue window＂. The operation time, intraoperative blood loss, length of incision, blood drainage and complication after operation were recorded. Oswestry disability index （ODI） and visual analogue scale （VAS） of pre-operation, 7 days, 1,3 and 12 months postoperatively were evaluated. [ Results ] 37 patients were followed up for an average of 15.2 ± 4.7 months （range, 13-25 months）. Intraoperative blood loss was 90-300 mL （average, 175.1 ± 71.8 mL）, operation time was 103-150 rain（average, 129.0 ± 12.0 rain）, length of incision was 5.1-6.0 cm （average, 5.4 _＋ 0.3 cm） and postoperative blood drainage was 80-240 mL（average, 116.5 ± 66.0 mL）. Postoperative lumbar and legs VAS score and ODI percent decreased significantly comparing with that of pre-operation （P 〈 0.05）. Lumbar VAS score was 6.6 ± 0.8 before operation and 0.7 ± 0.6 at 12-month follow-up. Legs VAS score was 7.0 ± 0.1 before operation and 0.6 ± 0.5 at 12-month follow-up. Average ODI percent was 68.6% ± 5.4% before operation and 6.2% ± 1.6% at 12-month follow-up. There were no internal fixation loosening and fracture, and the radiographic findings were consistent with the standard of the lumbar interbody fusion at last follow-up. [Conclusion] The minimally invasive treatment concept and the technology of ＂mobile skin and soft tissue window＂ are applied to the traditional posterior lumbar interbody fusion surgery, It not only can obtain good vision without special instruments, but also can significantly reduce the skin incision and muscle tissue dissection, get less surgical trauma, better functional recovery. It can obtain a satisfactory clinical effect for single segment lumbar degenerative disease.