小切口椎板间插装融合技术治疗腰椎管狭窄症的近期疗效

目的探讨经小切口局部椎板减压,椎板间插装融合(interlaminar lumbar instrumented fusion,ILIF)技术治疗腰椎管狭窄症的近期疗效。方法 2009年11月-2011年1月,采用经小切口椎板减压、ILIF治疗16例腰椎管狭窄症患者。男7例,女9例;年龄49～67岁,平均52.8岁。病程2年～9年4个月,平均4年7个月。16例均为退变性狭窄,4例合并双侧侧隐窝狭窄,3例合并腰椎间盘突出。病变节段:L3、42例,L4、54例,L5、S14例,L3、4和L4、5双节段2例,L4、5和L5、S1双节段4例。手术前后采用疼痛视觉模拟评分(VAS)、Oswestry功能障碍指数(ODI)进行临床疗效评定;CT扫描并测量椎管横截面面积。结果手术时间35～80 min,平均47 min;术中出血量120～350 mL,平均145 mL;住院时间4～15 d,平均7.8 d。除1例发生脑脊液漏,其余切口均Ⅰ期愈合。16例均获随访,随访时间12～22个月,平均14.8个月。术后CT扫描固定节段,示14例棘突间融合,2例可能融合;融合时间3～10个月,平均4.6个月。术后VAS评分、ODI及椎管横截面面积均较术前显著改善,差异有统计学意义(P<0.05)。结论 ILIF可兼顾椎板减压和重建后柱稳定性,同时保护脊髓,具有创伤小及操作简便的优点。

Short-term effectiveness of interlaminar lumbar instrumented fusion through a small incision for lumbar spinal stenosis

Objective To evaluate the short-term effectiveness of local laminectomy and interlaminar lumbar instrumented fusion(ILIF) through a small incision for lumbar spinal stenosis.Methods Between November 2009 and January 2011,16 patients with lumbar spinal stenosis were treated by local laminectomy and ILIF through a small incision.There were 7 males and 9 females with an average age of 52.8 years(range,49-67 years).Sixteen patients had lumbar degenerative stenosis with an average disease duration of 4 years and 7 months(range,2 years-9 years and 4 months).Four cases complicated by lateral recessus stenosis,3 by lumbar disc herniation.Involved segments included L3,4in 2 cases,L4,5in 4 cases,L5,S1in 4 cases,L3,4and L4,5(double segments) in 2 cases,L4,5and L5,S1(double segments) in 4 cases.The e ectiveness was evaluated with the pre-and post-operative Visual Analogue Scale(VAS) scores,Oswestry Disability Index(ODI).The cross-sectional areas of spinal canal were measured by CT scanning and were compared between pre-and post-operation.Results The average operative time was 47 minutes(range,35-80 minutes);the average blood loss was 145 mL(range,120-350 mL);and the average hospitalization days were 7.8 days(range,4-15 days).Cerebrospinal uid leakage occurred in 1 case,and healing of incisions by rst intention was achieved in the others.The patients were followed up 12-22 months(mean,14.8 months).CT scanning showed interspinous fusion in 14 cases and possible fusion in 2 cases after operation,with an average fusion time of 4.6 months(range,3-10 months).The postoperative VAS score,ODI,and cross-sectional area were signi cantly improved when compared with preoperative values(P < 0.05).Conclusion The ILIF can promote fusion between spinous processes,provide spine stabilization,and protect the spinal cord.The procedure has small incision,simple method of xation and fusion.