自研新型器械经皮腰椎融合术治疗腰椎滑脱

Percutaneous lumbar interbody fusion with novel self-developed instruments for lumbar spondylolisthesis

[目的]介绍一种自研新型器械经皮腰椎融合术的手术技术和初步临床效果。[方法] 2017年12月—2019年2月,23例腰椎峡部裂性滑脱症患者接受上述手术治疗。后正中线旁开6~9 cm作为进针点,对向滑脱节段椎间隙穿刺,导丝引导下椎间孔扩大成形。置入工作套管,内镜下行侧隐窝与椎间孔扩大减压。自制椎间扩张器逐级撑开椎间隙。然后,经皮置入椎弓根螺钉和连接棒行滑脱椎体提拉复位。通过自制工作通道放入铰刀和刮匙清理椎间隙和终板,镜下清理干净后,植入自体骨或同种异体骨,并置入椎间融合笼架。调整紧固钉棒系统,完成固定。[结果]所有患者均顺利完成手术,无严重并发症发生。末次随访时,腰痛和腿痛VAS评分、ODI评分、椎间隙高度、患椎滑脱距离均较术前明显改善(P<0.05)。CT显示椎间植骨均骨性愈合。[结论]本新型经皮腰椎融合术治疗腰椎峡部裂性滑脱症的手术技术可行,是一种安全、有效的微创手术方式。

[Objective] To introduce the surgical technique and preliminary clinical results of percutaneous lumbar interbody fusion with novel self-developed instrument for lumbar spondylolisthesis. [Methods] From December 2017 to February 2019, 23 patients underwent abovementioned surgical intervention for lumbar spondylolisthesis. Under guide of fluoroscopy, the puncture aiming to the sliding intervertebral space was conducted from the entry point 6~9 cm beside the posterior midline, and then the needle was replaced by a guide wire. Foraminoplasty was performed following the guide wire, and the endoscope and instruments were inserted to complete decompression of the lateral recess and intervertebral foramen. The novel self-developed instruments were used to dilate the narrowed intervertebral space in grades. After that, percutaneous pedicle screws and rods were placed to assist reduction of spondylolisthesis. Discectomy with complete remove of endplate cartilage was done with self-developed reamers and curators through working cannel under endoscopic vision, and then bone autograft and a cage were inserted into the space. Finally, the screw-rod system was adjusted to compress the intervertebral space and fastened. [Results] All patients were successfully operated on without serious complications. At the last follow-up, the VAS scores both for back pain and leg pain, ODI score, as well as height of intervertebral space and distance of spondylolisthesis measured on radiographs were significantly improved compared with those before operation(P<0.05). CT scanning revealed bony fusion of the affected intervertebral space in all patients at the last interview. [Conclusion] This percutaneous lumbar fusion with the novel self-developed instruments is a safe, effective and minimally invasive surgical method for lumbar spondylolisthesis.