退行性腰椎病手术损害控制策略研究

目的探讨退行性腰椎疾病手术过程损害控制的策略。方法引入手术损害控制理念,在退行性腰椎疾病手术过程中贯彻操作序贯化、剥切局限化、减压精准化、固定短节化、融合个性化、积极微创施术的策略,对退变性腰椎管狭窄症、腰椎侧凸失稳症、腰椎滑脱症融合167例患者施行后路椎管减压融合内固定术。结果患者术后随访3个月,日本骨科协会(JOA)评分显著高于术前(t=9.11,P<0.05),视觉模拟评分法(VAS)评分显著低于术前(t=3.24,P<0.05),平均侧凸Cobb角改善率为72.4%,平均滑脱复位率为86.3%;术后12个月,CT复查椎间融合率为81.7%。结论施行腰椎退行性疾病手术时,引入手术损害控制理念,制订相应手术策略并严格实施,可明显减少手术局部直接损伤,腰椎及神经功能可获得更好的恢复。

Objective To investigate the strategy of damage control during operation for degenerative lumbar spine diseases. Methods Introducing the concept of surgical damage control and implementing the strategies of sequential operation, localization of dissection,precise decompression,short fixation,individualized fusion and active minimally invasive operation during the operation of degenerative lumbar diseases,167 patients with degenerative lumbar spinal stenosis,lumbar scoliosis instability and lumbar spondylolisthesis were treated with posterior spinal canal decompression,fusion and internal fixation. Results After 3 months follow-up,the JOA score of the patients was significantly higher than that before operation(t=9.11,P < 0.05),while the VAS score of the patients was significantly lower than that before operation(t=3.24,P<0.05).The average improvement rate of scoliosis Cobb angle was 72.4%,and the average reduction rate of spondylolisthesis was 86.3%.12 months after operation,the rate of intervertebral fusion was 81.7%.Conclusion Introducing the concept of surgical damage control, formulating appropriate surgical strategies and implementing them strictly in the operation of lumbar degenerative diseases can significantly reduce the direct local injury of operation,and the recovery of lumbar vertebrae and nerve function can be better.