锚定板自稳型椎间融合器前路融合术治疗腰椎退变性疾病

目的 探讨锚定板自稳型椎间融合器经前路小切口腹膜外间隙入路治疗腰椎退变性疾病的临床疗效及手术技巧.方法 2010年7月至2011年9月我院采用锚定板自稳型椎间融合器经前路小切口腹膜外间隙入路治疗腰椎退变性疾病15例,男性9例,女性6例,年龄43～66岁,平均51岁.腰椎不稳症4例,腰椎间盘源性疼痛7例,腰椎滑脱症2例,腰椎间盘突出症术后翻修2例.L3～4节段2例,L4～5节段9例,L5～S1节段4例.15例患者均行前路小切口腹膜外间隙入路椎间融合术,且均为单节段手术.L3～4、L4～5节段采用左侧腹直肌旁切口,L5～S1节段采用右下腹横切口.记录手术前后Oswestry功能障碍评分(oswestry disability index,ODI)、疼痛视觉模拟评分(visual analog scale,VAS)、手术节段椎间隙高度、手术节段椎间隙角度、腰椎前凸角度(LL),术中出血量,手术时间,手术并发症,卧床天数,住院天数.定期复查腰椎X线片及腰椎CT,评价植骨融合情况.结果 切口长度平均6.2cm,术中出血量平均95ml,手术时间平均85min,术后平均卧床3d,住院天数平均10d.术中腹膜撕裂2例,术中予以缝合修补;术后髂骨取骨处疼痛8例,经2-3周镇痛治疗后缓解.15例患者均获得随访,随访时间平均6.7个月(3-16个月),术后腰腿痛症状明显缓解.ODI (满分50分)由术前平均57.4%降至术后平均21.7%,VAS(满分10分)由术前平均6.7降至术后平均2.8.手术节段腰椎间高度由术前平均8.1mm至术后平均13.3mm,手术节段腰椎间角度由术前平均11.3°至术后平均12.7°,腰椎前凸角度由术前平均44.7°至术后平均52.3°.术后腰椎X线及CT示所有患者椎间植骨均已获得骨性融合.结论 带锚定板自稳型椎间融合器经前路小切口腹膜外间隙入路治疗腰椎退变性疾病,可获得满意的近期临床效果,并且创伤小、术后恢复快、植骨融合率高.

The application of anterior lumbar interbody fusion with self-stabilized anchor plate interbody fusion cagein the treatment of degenerative lumbar disorders

Objective To investigate the clinical outcomes and surgical techniques of the anterior lumbar interbody fusion （ALIF） with self-stabilized anchor plate interbody fusion cage with an anterior minimally invasive approach in the treatment of lumbar degenerative disorders. Methods From July 2010 to September 2011, 15 cases of the ALIF self-stabilized anchor plate interbody fusion cage with an anterior minimally invasive approach were enrolled in this study, including 9 males and 6 females. The mean age was 51 years old （range; 43-66 years）. The results of preoperative diagnosis were lumbar spine instability in 4 cases, discogenic low back pain in 7, lumbar spondylolisthesis in 2, and revision for failed lumbar disc herniation surgery in 2. The affected segments were L3.4 in 2 cases, L4_5 in 9 cases, and Ls-S1 in 4 cases. All oft_he 15 cases underwent single level fusion. The left lateral rectus incision was made at L3.4 and L4_5. Transverse incision in the right lateral abandom was made at L：SI. Oswestry disability index （ODI）, visual analog scale （VAS）, the height of dics space of operational segment, the angle of dics space of operational segment, the lumbar lordosis, the blood loss during surgery, the operation time, the complications, the days in bed, and the hospital stay were recorded. Bone graft fusion was evaluated by CT and X-rays taken routinely during the follow-up. Results The average length of incision was 6.2cm. The average blood loss during surgery was 95ml. The average operation time was 85 minutes. The average postoperative days in bed was 3 days. The average hospital stay was 10 days. Peritoneum dehiscence which was sutured during surgery occurred in 2 cases. Pain of donor site in iliac bone after surgery occurred in 8 cases, and it was relieved after 2-3 weeks＇ analgesia treatment. All 15 cases were followed up for an average of 6.7 months （range; 3-16 months）. The symptoms of lumbar and limb pain were relieved significantly after surgery. ODI （full mark： 50） decreased from 57.4% preoperatively to 21.7% postoperatively. VAS （full mark： 10） decreased from 6.7 preoperatively to 2.8 postoperatively. The height of disc space of operational segment ascended from average 8.1ram preoperatively to average 13.3mm postoperatively. The angle of disc space of operational segment ascended from preoperative average 11.3~ to postoperative average 12.7~, and lumbar lordosis angle ascended from preoperative average 44.7~ to postoperative average 52.3~~ Bone graft fusion of all patients had been showed by CT and X-rays of lumbar postoperatively. Conclusions The short-term clinical outcomes of ALIF with self-stabilized anchor plate interbody fusion cage with an anterior minimally invasive approach in the treatment of lumbar degenerative disorders are satisfactory. The advantages include small incision, early ambulation, and high bone fusion rate.