后路椎间融合术治疗老年腰椎间盘突出症的安全性

目的探讨后路椎间融合术治疗老年椎间盘突出症的方法、应用价值及安全性。方法对89例确诊为老年椎间盘突出症的患者进行开放后路椎间融合术,包括后正中开放入路,扩大开窗、半椎板或全椎板切除,椎管扩大成形,椎弓根螺钉植入,椎间撑开切除椎间盘,刮除终板软骨层,植入经修剪的颗粒骨、大块关节突骨块、椎板骨块,或椎间Cage融合器,椎弓根螺钉系统加压固定。结果所有患者术前均经详尽检查除外绝对手术禁忌,其中约65%曾请相关科室会诊指导围手术期处理。平均手术时间为100min,平均失血量350mL。所有病例均经术后随访,随访时间为12～24个月,原有的神经压迫症状基本恢复,无间隙性跛行,下腰痛较术前明显缓解,患者满意率91%。椎间高度术前3.4～7.8mm,平均高度5.1mm,术后3个月椎间高度9.6～12.4mm,平均11.2mm。在12个月随访时平均高度为9.0～12.1mm,平均为10.8mm。12个月椎间融合率91.0%。主要并发症为:10例患者出现神经根刺激症状,4例患者出现脑脊液漏,均缓解,无一例出现严重感染或危重并发症。结论应用后路椎体间融合技术结合椎弓根钉棒固定技术治疗老年腰椎间盘突出症能够充分减压,恢复并维持椎间隙高度,重建腰椎稳定性,并具备手术安全性。

Safety of posterior lumbar interbody fusion in the treatment of elderly patients with lumbar disc herniation

Objective To investigate the posterior lumbar interbody fusion(PLIF) in the treatment of senile disc herniation.Methods Eighty-nine elder patients with lumbar disc herniation were subjected to open posterior lumbar interbody fusion,including middle open approach,expanded window by half laminectomy or laminectomy,laminoplasty,pedicle screw implantation,removal of intervertebral disc,scraping the endplate cartilage layer,implantation of pruning granular bone or facet bone lamina bone,or interbody Cage fusion,compression and fixation of pedicle screw system.Results All patients were confirmed by detailed checks to exclude absolute contraindications for surgery,of which approximately 65% had asked relevant departments for consultation to guide perioperative management.The average operative time was 100 min,and the average blood loss was 350 mL.All cases were postoperatively followed up for 12 to 24 months.Most of the original nerve compression symptoms were relieved without intermittent claudication,and lower back pain significantly alleviated.Patient satisfaction rate was 91%.The intervertebral height before operation was 3.4-7.8 mm(mean 5.1 mm),and at 3rd month after operation it was increased to 9.6-12.4 mm(mean 11.2 mm).The average height at 12th month was 9.0-12.1 mm(mean 10.8 mm).Interbody fusion rate at 12th month was 91.0%.Major complications were nerve root irritation(10 cases),and cerebrospinal fluid leakage(4 cases),and all of them were relieved.There were no cases of serious infection or critical complications.Conclusion PILF combined with pedicle screw fixation technique in the treatment of elderly patients with lumbar disc herniation can fully decompress,restore and maintain the height of the intervertebral space,and reconstruct the lumbar spine stability with surgical safety.