双牵开摆动椎间盘镜技术治疗多节段腰椎间盘突出症

目的 评价双牵开摆动椎间盘镜技术治疗多节段腰椎间盘突出症的临床效果.方法 2006年12月至2009年11月,应用双牵开摆动椎间盘镜技术治疗多节段腰椎间盘突出症85例,椎间盘突出合并腰椎管狭窄53例,椎间盘突出伴腰椎失稳15例.两处开窗105例,三处开窗33例,四处开窗13例,五处开窗2例;15例伴腰椎失稳者行"全合"膨胀式融合器椎间融合+椎弓根钉内固定术.根据Macnab评分标准评价疗效.结果 术后随访3～36个月,平均16个月.两处开窗减压手术时间平均45min,三处开窗61 min,四处开窗83 min,五处开窗110 min;"全合"膨胀式融合器椎间融合+椎弓根钉内固定者另平均增加92min.术中出血量平均150ml;术中发生硬膜囊撕裂1例,马尾轻度损伤1例;术后发生切口浅表感染1例,下肢静脉血栓形成1例,"全合"膨胀式椎间融合器翻修1例.患者术后1～3 d下床活动,平均住院10d.疗效:优117例,良32例,可4例.132例患者术后3周内恢复原工作或生活.结论 双牵开摆动椎间盘镜技术应用时不必过度倾斜工作通道即可满足对临近椎间隙的手术操作要求,操作难度相对降低、显露理想、神经双牵开应力分散,更有利于保护神经,减压彻底,效果优良.

Abstract：

Objective To evaluate the effect of double tractors swing microendoscopic discectomy technique in multi-segmental lumbar disc herniation. Methods From December 2006 to November 2009,153 patients with multi-segmental lumbar disc herniation were treated with double tractors swing microendoscopic discectomy. They included 85 cases of multi-segmental disc herniation, 53 cases of degenerative canal stenosis and 15 cases of lumbar instability. Among them, 2, 3, 4 and 5 fenestrations were performed in 105,33, 13 and 2 cases respectively and interbody fusion was done with "quanhe" inflation cage and screws in 15 cases. The results were evaluated with Macnab scale. Results All the 153 patients were followed from 3to 36 months, with an average of 16 months. The mean operative time was 45, 61, 83 and 110 min for 2,3,4 and 5 fenestrations respectively, with a mean blood loss of 150 ml. And it took extra 92 min to finish interbody fusion. Complications included dural sac tears in 1 case,canda equina slight lesion in 1, superficial incision infection in 1, the formation of deep venous thrombosis in 1, and revision for"quanhe"inflation cage in 1. The mean hospital stay was 10 days. Excellent results were obtained in 117 cases, good in 32 and fair in 4. One hundred and thirty-two patients returned to their work or normal activities in 3 weeks. One hundred and forty-nine cases were satisfied with the therapeutic effect. Conclusion This technique not only can reach adjacent intervertebral space easily but also disperse pressure on the nerve root effectively. This technique can provide thorough decompression and good results.     

腹腔镜辅助下经前后路治疗重度腰椎滑脱症

 目的 评价腹腔镜辅助下经前后路手术治疗重度(芋、郁度)腰椎滑脱症的手术操作方法及临床疗效。方法 2007年 12月至 2010年 5月, 采用后路椎间盘镜行双侧神经二次减压、经皮椎弓根钉复位及前路腹腔镜下椎间植骨钛板内固定融合治疗芋、郁度腰椎滑脱症患者 13例, 男 6例, 女 7例;年龄 18~58岁, 平均 39.8岁。芋度滑脱患者 11例, 郁度滑脱患者 2例。滑脱部位: L4,5 2例, L5S1 11例。根据滑脱率、滑脱角、椎间隙后高度改变及临床 Oswestry功能障碍指数评估疗效。结果术后随访 12至 36个月, 平均 21个月。手术时间 105~150 min,平均 125 min;出血量 200~900 ml, 平均 415 ml。滑脱率减小 56.9%(术前 73.3%±6.1%, 术后 16.4%±9.5%);滑脱角减小 19.6°(术前 27.7°±5.6°, 术后 8.1°±8.8°);椎间隙后高度增大 7.1 mm[术前(2.6±0.8) mm, 术后(9.7±3.7) mm]。临床 Oswestry功能障碍指数下降 19.5分[术前(35.8±5.7)分, 术后(16.3±5.2)分]。 CT扫描术后 1年椎体间均骨性融合。术中发生硬膜囊撕裂 l例, 切口浅表感染 1例。疗效优 4例, 良 8例, 可 1例。结论腔镜辅助下经前后路手术治疗芋、郁度腰椎滑脱症可实现彻底减压及尽可能的解剖复位, 前后内固定协同稳定性好, 椎间植骨融合可靠, 手术创伤小, 临床疗效满意。     

先天性青少年脊柱重度侧凸一定要做截骨术吗?

The spine in the AIS patients is usually quite flexible.Most of them seek for correction are usually in the range of 50 to 70°(Cobb angle).They can be corrected by one stage posterior approach,using either hybrid or all pedicle screw method,with good results.Also,some surgeons may prefer anterior approach for correction.