小切口椎板开窗椎间融合联合经皮椎弓根钉固定治疗腰椎退行性疾病临床研究

Clinical study on the treatment of lumbar degenerative disease with minimally invasive fenestration Interbody fusion and percutaneous pedicle screw fixation

目的:探讨小切口椎板开窗椎间融合联合经皮椎弓根钉固定治疗腰椎退行性疾病的临床疗效。方法:选择腰椎退行性疾病患者50例,其中腰椎间盘突出症23例,腰椎管狭窄症18例,腰椎Ⅰ~Ⅱ度滑脱9例。应用小切口椎板开窗椎间融合联合经皮椎弓根钉固定手术治疗,统计两组术中出血量、手术时间、术后引流量,术前术后疼痛视觉VAS评分、Oswestry功能障碍指数(ODI),根据Macnab标准评定临床疗效。结果:术后随访9~25个月,平均16个月。手术时间(121.00±26.45)min;术中出血量(340.65±94.26)ml;术后引流量(156.36±43.73)ml。术后第3天、末次随访的VAS评分、ODI评分与术前比较,差异有统计学意义(P<0.05)。末次随访Mac Nab评价临床疗效:优37例(74%),良11例(22%),可1例(2%),差1例(2%),总优良率达96%。结论:小切口椎板开窗椎间融合联合经皮椎弓根钉固定治疗腰椎退行性疾病具有创伤小,术中出血少,术后恢复快,临床疗效显著等优点,值得在临床中推广应用。

Objective To explore the clinical effect of small incision combined with lumbar interbody fusion combined with percutaneous pedicle screw fixation in the treatment of lumbar degenerative diseases. Method 50 cases of patients with lumbar degenerative disease were selected,which the lumbar disc herniation in 23 cases,lumbar spinal stenosis in 18 cases,lumbar spondylolisthesis in 9 cases. Treatment of lumbar interbody fusion combined with percutaneous pedicle screw fixation with small incision. Operation time,intraoperative bleeding,and postoperative drainage volume. Pre-and postoperative back pain was assessed by visual analogue scale（ VAS）,and lumbar function was evaluated by Oswestry disability index（ ODI）,the clinical results were assessed by Macnab criterion. Results Patients were followed up for 9 ~ 25 months,mean 16 months. The time of operation,the blood loss in the operation,and postoperative drainage volume were（ 121. 00 ± 26. 45） min,（ 340. 65 ± 94. 26） ml,（ 156. 36 ±43. 73） ml. There were significant differences in VAS score,ODI score and preoperative and postoperative third day and last follow-up（ P〈0. 05）. Clinical efficacy of the last follow-up Mac Nab evaluation： excellent in 37 cases（ 74%）,good in 11 cases（ 22%）,possable in 1 case（ 2%）,poor in 1 case（ 2%）,the total excellent rate was 96%. Conclusion Minimally invasive fenestration Interbody fusion and percutaneous pedicle screw fixation can achieve satisfactory clinical result in the treatment of lumbar degenerative disease. It has the advantages of less trauma,less bleeding,rapid postoperative recovery,and obvious clinical curative effect. It is worth to be popularized in clinical practice.