全腹腔镜下前路L_5S_1融合术的中期疗效

Mid-term outcomes of anterior L_5S_1 lumbar interbody fusion under full laparoscopy

[目的]观察全腹腔镜下前路L_5S_1融合术的中期随访结果。[方法]本院2006年1月~2012年1月收治L_5S_1椎间盘突出症或L_5滑脱症患者42例,男26例,女16例;年龄18~53岁,平均(35.71±10.37)岁。L_5S_1椎间盘突出症32例,L_5滑脱症10例。均行腹腔镜下前路L_5S_1椎间盘切除椎间融合术治疗。采用VAS评分和影像学测量,如椎间隙高度和植骨融合情况,评估临床效果。[结果]所有病例随访6~9年,平均(7.14±0.78)年。42例患者均获得骨性融合,融合时间3~12个月,平均(4.50±2.50)个月。VAS评分由术前(5.79±1.09)分,显著减少至术后1周时(1.79±0.72)分,末次随访时(1.00±0.66)分,差异有统计学意义(P<0.05)。椎间隙高度术前平均(7.30±0.54)mm,术后1周复查为(13.93±0.99)mm,末次随访为(13.70±0.80)mm,术后1周及末次随访与术前差异有统计学意义(P<0.05),末次随访与术后1周差异无统计学意义(P>0.05)。随访期间未出现椎间融合器移位、逆行射精、肠粘连等并发症。[结论]全腹腔镜下前路L_5S_1椎间盘切除椎间融合术中期随访效果满意,在严格把握适应证并具备相关专科技术的前提下推广应用。

[Objective] To explore the mid-term outcome of anterior L5S1 lumbar interbody fusion under full laparoscopy.[Methods] From January 2006 to January 2012,42 patients with L5S1 disc herniation or L5 spondylolisthesis received anterior laparoscopic lumbar spine fusion,including 26 males and 16 females aged from 18 to 53 years with an average of（35.71±10.37）years.The visual analogue scale（VAS） of pain and radiographic assessments,such as the intervertebral disc height and intervertebral fusion were used for evaluation of the clinical consequences.[Results] All the patients were followed up for 6 to 9 years with an average of（7.14±0.78） years.The VAS statistically decreased from（5.79±1.09） preoperatively to（1.79±0.72） at 1 week postoperatively,further to（1.00±0.66） at the latest follow up（P〈0.05）.The intervertebral bony fusion achieved in all patients from 3 to 12 month with an average of（4.50±2.50） months.In addition,the intervertebral height varied from（7.30±0.54） mm preoperatively to（13.93±0.99） mm at 1 week postoperatively to（13.70±0.80） mm at the latest follow up,there were statistical differences compared those before operation with these at 1 week postoperatively and at the latest follow up（P〈0.05）,although on a statistical difference was noted between those at 1 week after operation and at the latest follow up（P〉0.05）.During the period of follow up,no complication,such as displacement of the cage,retrograde ejaculation and intestinal adhesions happened in any patient.[Conclusions] Laparoscopic anterior lumbar spine fusion does achieve satisfactory mid-term clinical outcomes,if strict indications are selected,as well as proper equipment and handling technique are available.