双侧小切口椎旁肌间隙入路在下腰椎融合术中应用

目的]探讨双侧小切口椎旁肌间隙入路在下腰椎融合术中的应用价值。方法]自2008年6月～2009年10月,选择性对32例单节段下腰椎疾患行椎弓根螺钉加椎间融合器内固定术,均采用双侧小切口椎旁肌间隙即Wilt-se多裂肌和最长肌肌间隙入路。其中男性14例,女性18例;年龄37～65岁,平均51.2岁;病变节段:L3、46例,L4、517例,L5S19例;病种类型:腰椎退行性不稳12例,极外型或椎间孔型椎间盘突出7例,腰椎滑脱5例,椎间盘原位复发5例,椎间盘源性疼痛3例,均表现为严重的下腰痛伴单侧肢体出现放射症状或无双下肢症状。根据Oswe-stry功能障碍指数(ODI)评分和伤口视觉模拟法(VAS)疼痛评分来评估疗效。结果]手术平均时间106 min,术中平均出血量319 ml,术后平均引流量137 ml,住院平均天数13.5 d。术前ODI评分为(37.3±6.1)分,术后3个月时为(19.1±4.7)分,末次随访时为(11.8±3.7)分;术前VAS疼痛评分为(7.2±1.2)分,术后3个月时为(2.5±0.7)分,末次随访时为(2.1±0.9)分,统计分析显示术前和术后3个月或末次随访时的ODI、VAS评分差异均有统计学意义(P<0.05)。所有病例均获得24个月以上随访,影像学检查示良好的椎间骨性融合现象。结论]双侧小切口椎旁肌间隙入路行下腰椎融合术能有效地保护椎旁肌,并达到减压、融合目的,是较实用并容易推广的腰椎后路"微创"手术方式。

Clinical application of double small incision with paraspinal approach for lower lumbar fusion

Objective]To investigate the clinical value of applying double small incision with paraspinal approach for lower lumbar fusion. Methods]From June 2008 to October 2009,32 patients with one-level low back disorder were treated with pedicle screw fixation and interbody fusion cage,using double small incision with Wiltse paraspinal approach.There were 14 male and 18 female,with the age ranging from 37 to 65 years(average,51.2 years),including 12 cases of lumbar degeneration instability,7 cases of far lateral or foraminal disc herniation,5 cases of lumbar spondylolithesis,5 cases of post discectomy recurrence,3 cases of discogenic low back pain.All cases showed serious low back pain with one side radiated pain or no radiated pain,6 cases were at L3、4 level,and 17 at L4、5,9 at L5S1.The clinical effects were evaluated according to Oswestry disability index(ODI) and visual analog scale(VAS) scores. Results]The mean operation time was 106 min,surgical blood loss was 319 ml,surgical draining loss was 137 ml,hospital stay was 13.5 d.The average ODI scores decreased from preoperative 37.3±6.1 to 11.8±3.7 at the final follow-up(P<0.05).The average VAS scores decreased from preoperative 7.2±1.2 to 2.1±0.9 at the final follow-up(P<0.05).All cases were observed solid fusion at 24 months postoperatively. Conclusion]The double small incision with paraspinal approach for lower lumbar fusion can protect paraspinal muscle effectively,and attain decompression completely or interbody fusion.It is practical spine surgery method with minimal invasion.