单纯椎间融合器腰椎前路融合术治疗腰椎退变性疾病

 目的 探讨采用经腹膜外入路单纯椎间融合器腰椎前路融合术治疗腰椎退变性疾病的临床疗效。方法 34例患者, 男 10例, 女 24例；年龄 26~67岁, 平均 52岁。腰椎退变性滑脱 11例, 腰椎间盘源性疼痛 21例, 后路手术后复发前路翻修 2例。 L4, 5间隙 12例, L5S1间隙 20例, L4, 5、L5S1双间隙 2例。 34例患者均行下腹部小切口经腹膜外入路椎间盘切除单纯椎间融合器植骨融合术, 切口长度平均 7 cm, 记录手术时间、出血量和围手术期并发症。采用疼痛视觉模拟评分(visual analogue scale, VAS)和 Oswestry功能障碍指数(Oswestry disability index, ODI)评估患者术后症状改善情况。定期复查并摄腰椎 X线片及 CT, 观察脊柱融合情况。结果均顺利完成手术, 手术时间平均 90 min, 失血量平均 200 ml。 1例出现下腔静脉分叉处撕裂, 经修补后完成手术；1例出现腹膜撕裂, 予以修补。均获得 12~60个月随访, 平均 36个月。术后腰痛及下肢痛症状明显缓解, 均恢复正常生活和工作。 VAS评分由术前平均 7分, 降至未次随访时平均 0.5分。 ODI由术前平均 41%, 降至末次随访时平均 6%。除 1例外均未发现椎间融合器移位, 椎间临床融合率 97%。结论腹膜外入路腰椎前路融合不仅创伤小, 还可彻底切除退变椎间盘, 压应力侧大面积植骨, 融合率高, 术后可早期下床, 利于康复和护理。

Clinical application of stand-slone-cage for anterior lumbar interbody fusion in degenerative disc diseases

Objective To evaluate the effectiveness at anterior lumbar interbody fusion (ALIF) with a single cage alone in treatment of lumbar degenerative disc disease (DDD).Methods Thirty-four patients aged from 26 to 67 years (mean,52) were enrolled in this study,including 10 males and 24 females.Preoperative diagnosis included:degenerative spondylolithesis in 11 cases,discogenic low back pain in 21,and revision for failed posterior surgery in 2.Objective level located in L4.5 in 12 cases,L5S1 in 20,and double discs (L4.5,L5S1) in 2.All the patients received extraperitoneal approach ALIF.Surgical time,blood loss,perioperative complications and postoperative ambulation were noted.Postoperative function status was evaluated by 100 mm Visual Analog Scale (VAS) and Oswestry Disability Index (ODI50).AP,lateral and dynamic X-rays were routinely taken during follow up,according to which disc height,migration of implant and bony fusion were measured.Results All the surgeries were performed successfully with a mean surgical time of 90 min and blood loss of 200 ml.An injury to the bifurcation of vena cave was encountered in an early case,after meticulous repairing of the vessel,the surgery was finished successfully.Peritoneum rupture was noticed in one case.One case of postoperative cage migration was revised and reinforced with additional fixation system.All the patients were followed up for an average of 36 months (range,12-60).All the patients were satisfied with the pain relief and returned to normal social life and working.VAS decreased from preoperative 70 to postoperative 5,and ODI decreased from 41％ to 6％.All but one migration case reached sound fusion with a fusion rate of 97％.Conclusion Owing to multiple advantages,complete removal of degenerative disc,compressive bone graft,sufficient graft area,early ambulation,less complication,extrapefitoneal approach for ALIF comes up with satisfying clinical outcomes.This mini_invasive technique provides a valuable alternative to treatment of lumbar DDD when appropriate indication is selected.