摘要
目的探讨采用前路自锁式椎间融合器治疗中央型腰椎间盘突出症合并隐性腰椎不稳的临床疗效。 方法2010年3月－2012年2月，对31例中央型腰椎间盘突出症合并隐性腰椎不稳患者行前路小切口腹膜外间隙入路减压、自锁式椎间融合治疗。其中男20例，女11例；年龄34～58岁，平均46岁。病程5～32个月，平均16个月。均为单节段病变，病变节段：L3、4 2例，L4、5 20例，L5、S1 9例。记录手术时间、术中出血量、卧床时间、住院时间、手术并发症；统计术前及末次随访时Oswestry功能障碍指数（ODI）、疼痛视觉模拟评分（VAS）；复查腰椎X线片和腰椎三维CT成像，评价手术节段椎间隙高度、椎间Cobb角变化及植骨融合情况。 结果手术时间平均102 min，术中出血量平均121 mL，卧床时间平均5 d，住院时间平均11 d。术中腹膜撕裂2例、腰升静脉撕裂1例，术后脑脊液漏1例、髂骨取骨处疼痛4例、非对称性下肢皮温升高2例，均经对症治疗后缓解。31例均获随访，随访时间12～28个月，平均20个月。术后未出现感染、复发，未发现下肢深静脉血栓形成、逆向射精等并发症；术后3个月腰椎MRI示减压彻底。末次随访时ODI评分、腰痛VAS评分、下肢痛VAS评分、手术节段椎间隙高度、椎间Cobb角均较术前显著改善，比较差异均有统计学意义（P 〈 0.05）。末次随访时，CT扫描示31例患者椎间植骨均已达骨性融合。 结论小切口腹膜外间隙入路减压、自锁式椎间融合治疗中央型腰椎间盘突出症合并隐性腰椎不稳，避免了对腰椎后方结构的破坏，具有创伤小、出血少、即刻稳定、植骨融合率高等优点，术后疗效满意。
Objective To evaluate the effectiveness of anterior; lumbar interbody fusion （ALIF） with self-locked Cage in the treatment of central type lumbar intervertebral disc protrusion and recessive lumbar segmental instability. Methods Between March 2010 and February 2012, 31 patients with central type lumbar intervertebral disc protrusion and recessive lumbar segmental instability were treated with decompression and ALIF assisted by self-locked Cage through the mini-incision and retroperitoneal approach. There were 20 males and 11 females with the mean age of 46 years （range, 34-58 years）. And the disease duration ranged from 5 to 32 months （mean, 16 months ）. The lesion located at the L3, 4 level in 2 cases, L4, 5 in 20 cases, and L5, S1 in 9 cases. The operation time, intraoperative blood loss, bedridden time, hospitalization time, and complications were recorded. The effectiveness was evaluated by Oswestry disability index （ODI） and visual analogue scale （VAS）. Lumbar X-ray films and three-dimensional CT scan were taken to evaluate the fusion and the variation of the height and Cobb angle of intervertebral space. Results The mean operation time was 102 minutes; the mean intraoperative blood loss was 121 mL; the mean bedridden time was 5 days; and the mean hospitalization time was 11 days. Intraoperative peritoneum tear and ascending lumbar vein tear, postoperative cerebrospinal fluid leakage, pain at donor site, and asymmetric elevated skin temperature of the lower extremity occurred in 2 cases, 1 case, 1 case, 4 cases, and 2 cases respectively, which were relieved after symptomatic treatment. All cases were followed up 12-28 months （mean, 20 months）. No infection, recurrence, deep venous thrombosis, or retrograde ejaculation was observed after operation. MRI showed complete decompression at 3 months after operation. At last follow-up, the scores of ODI, VAS of lumbars and lower limbs, the intervertebral height, and Cobb angle were significantly improved when compared with preoperative ones （P 〈 0.05）; CT scan showed bone fusion in all cases. Conclusion The clinical outcome of ALIF with self-locked Cage through mini-incision and retroperitoneal approach is satisfactory in treatment of central type lumbar intervertebral disc protrusion and recessive lumbar segmental instability. It can retain the posterior spinal construction and has the advantages of less trauma and bleeding, immediate stability, high bone fusion rate, and so on.
出处
《中国修复重建外科杂志》
CAS
CSCD
北大核心
2014年第1期69-73,共5页
Chinese Journal of Reparative and Reconstructive Surgery
关键词
前路手术
椎间融合
中央型腰椎间盘突出症
隐性腰椎不稳
Anterior approach Interbody fusion Central type lumbar intervertebral disc protrusion Recessive lumbar segmental instability
