综合微创手术治疗腰椎滑脱的疗效观察

目的观察取袋鼠体位,经腰长短肌肌间隙入路置钉,二支撑点着力提拉复位等(下称综合微创)措施对腰椎滑脱进行经后路椎弓根钉棒复位,椎间植骨融合的手术效果。方法自2006年1月至2011年1月,对58例需要手术治疗的I～III度的腰椎滑脱患者,采用综合微创手术。并进行为期12～29个月随访,平均15个月。观察手术时间,术中出血量,手术创伤,手术并发症,临床效果,滑脱角和椎间高度,滑脱复位率及融合率。结果手术时间90～130min,平均110min,出血量200～600mL,平均350mL。无硬脊膜撕裂。术后2例患肢皮肤麻木加重,3个月后恢复。2例患肢仍疼痛,2周后消失。切口全部I期愈合。术后1周内X线检查,54例滑脱完全复位,4例复位率>90%。末次随访未见复位丢失,融合率98.2%。未发生断钉、断棒。无"融合病"发生。结论综合微创手术措施治疗I～III度腰椎滑脱,手术时间短,创伤小,出血少,减压彻底,并发症少,滑脱椎复位、融合率高,临床疗效优良。

Minimally Invasive Surgical Treatment of Lumbar Spondylolisthesis

Objective To study the surgical effect of posterior transpedicular screw and rod reduction and lumbar interbody fusion via a series of procedures such as placing screws through the psoas major and psoas minor space, elevating, pulling and reduction on two supporting points and so on （called minimally invasive）, on patients with spondylolisthesis operated in a kangaroo posture. Methods From January 2006 to January 2011, 58 patients with Grade I - III spondylolisthesis underwent minimally invasive surgery and the follow-up of the operated patients was between 12 and 29 months （an average of 15 months）. The operative time, blood loss of operation, surgical wounds, complications, clinical effects, slip angle, intervertebral height, reduction rate and fusion rate were reviewed and evaluated, retrospectively. Results The mean operative time was 110 minutes （range 90 to 130） and the average blood loss was 350 mL （range 200 to 600）. No dural tear was noted. 2 cases developed increasing skin numbness following surgery, which recovered three months later, while pain remained in 2 patients after operation, which resolved two weeks later. All surgical incisions achieved primary healing. X-rays, taken one week after surgery, showed that 54 cases demonstrated complete reduction and the reduction rate of 4 cases is greater than 90%. At final follow-up, neither loss of reduction nor screw or rod breakage was observed. The fusion rate reaches 98.2%. Besides, operatively induced worsen and intractable pain did not occur in any cases. Conclusion The minimally invasive approach is an efficient treatment of Grade I to III spondylolisthesis, with significant advantages of short operative time, less surgical wounds and complications, decreasing blood loss, thorough decompression, high reduction and fusion rate as well as excellent clinical outcome.