多裂肌间隙入路单侧椎弓根螺钉固定治疗复发性腰椎间盘突出症

目的：探讨经多裂肌肌间隙入路、单侧Cage椎间融合、椎弓根螺钉内固定治疗复发性腰椎间盘突出症的临床疗效。方法对29例经单侧椎间隙开窗髓核摘除术治疗的复发性腰椎间盘突出症患者,行经多裂肌间隙入路、单侧Cage椎间融合、椎弓根螺钉内固定术治疗。采用日本骨科协会评分（JOA）系统和视觉疼痛模拟评分（visualana-loguescores,VAS）系统对患者术前、术后和末次随访时的神经功能及自觉症状进行评价,并对结果进行统计学分析。结果29例患者再次术后均获得随访,随访时间5~33个月,平均26个月。JOA评分：术前（9.08±3.05）分；术后1个月（20.36±5.23）分；末次随访为（19.92±5.13）分；与术前相比有统计学意义（P〈0.01）。腰腿痛（VAS）评分：术前为（6.89±0.93）分,术后1个月为（2.36±0.83）分,末次随访为（2.19±0.61）分,术后及末次随访时较术前均有明显改善（P〈0.01）；椎间植骨融合率86.2%；未发现椎弓根螺钉松动、拔出、断裂以及Cage移位。结论经多裂肌肌间隙入路、单侧Cage椎间融合、椎弓根螺钉内固定治疗复发性腰椎间盘突出症可取得满意疗效。

Unilateral pedicle screw fixation through multifidus muscle gap in the treatment of recurrent lumbar disc herniation

Objective To explore the efficacy of unilateral pedicle screw fixation through multifidus muscle gap in the treatment of recurrent lumbar disc herniation.Methods After 29 patients with recurrent lumbar disc herniation underwent unilateral pedicle screw fixation through multifidus muscle gap,the neurologic function and subjective symptoms before and after operation,and in the last follow-up,were evaluated with JOA scoring system and Visual Analogue Scores （VAS）.The results were statistically analyzed.Results All patients were followed up for 5-33 months,mean 26 months.The JOA score before and after operation,and in the last follow-up was （9.08± 3.05）,（20.36±5.23）,and （19.92±5.13）,respectively,with statistical significance among the scores （P〈0.01）. The VAS of lumbocrural pain before and after operation,and in the last follow-up was （6 .8 9 ± 0 .9 3 ）,（2 .3 6 ± 0.83）,and （2.19±0.61）,respectively,with significant difference between the pre-operation and last follow-up scores （P〈0.01）.The rate of fusion reached 86.2%.No screw loosing,extraction,rupture or Cage displacement was observed.Conclusion Unilateral pedicle screw fixation through multifidus muscle gap is effective in the treat-ment of recurrent lumbar disc herniation.