经后路椎间盘镜下椎体支柱块治疗腰椎间盘突出伴腰椎不稳症的疗效观察

目的 初步探讨后路椎间盘镜下椎体支柱块治疗腰椎间盘突出伴腰椎不稳症的临床疗效.方法 回顾分析我院2008年11月～2012年4月收治腰椎间盘突出伴腰椎不稳症患者67例,其中男性32例,女性35例,年龄40～66岁,平均47.3岁.共80个间隙手术,均行后路椎间盘镜下减压结合椎体支柱块椎间隙自体骨植骨融合术.观察手术时间,术中出血量,术前及术后日本腰椎JOA评分以及Oswestry功能障碍指数(ODI)和椎间隙高度的变化.结果 67例患者均获得随访,随访时间6～18个月.术中平均出血120ml,手术平均时间55分钟,平均住院时间7.9天.2例患者术后出现神经根激惹症状,1周后症状消退.所有患者术后腰腿疼痛症状较术前均有不同程度的恢复.术后JOA评分明显高于术前,ODI评分明显低于术前(P＜0.05),椎间隙高度维持良好,置入后12个月,平均椎间隙高度丢失率为9.60％,手术优良率94.0％.结论 该方法可以替代传统的开窗减压手术方法,具有创伤小、椎间隙高度丢失率低、复发率低等优点,取得了比较满意的临床效果,值得推广使用.

Observation on therapeutic effect of posterior lumbar interbody fusion using Pillar Vertebral Spacer with Microendoscopy Diseetomy for lumbar disc herniation accompanying degenerative instability

Abstract] Objective To explore the effect of Pillar Vertebral Spacer for lumbar discherination associated with degenerative lumbar instability with MED. Methods Retrospective analyzed on 67 patients who were diagnosised with lumbar discherination associated with degenerative lumbar instability. 32 patients were male and 35 patients were female, the average age was 47.3 years old. All of them including 80 discs were treated with Vertebral pillar in combination with autogenous morselized bone. Patients were graded postoperatively with JOA scoring system, Oswestry disfunction index(ODI) and the change of the height of vertebrae interval. Results All were followed-up from 6 to 18 months. The intra-operative mean blood loss amount was 120ml, the average time was 55 minutes, and the mean hospital stay was 7.9 days. Only 2 patient had neural root agitation afte operation, and the symptom disapered a week later. The lower back pain and leg pain were relieved significantly in all patients after operation. Meanwhile the JOA scores increased prominently (P<0.05), the ODI dropped prominently (P<0.05) and the height of intervertebral space maintained well.At one year after operation, the mean losing height of vertebrae interval was 9.60% while The curative rate was 94.0%. Conclusion Pillar Vertebral Spacer for lumbar discherination associated with degenerative lumbar instability treated by MED could substitute for traditional vertebral plate decompression by fenestration, with the advantage of less trauma, low probability of relapse rate and lost of the height of intervertebral space. It has achieved satisfactory clinical result and deserved to be spread.