经骶棘肌肌间入路应用APERTURE工具治疗腰椎滑脱症

目的：探讨使用Moss Miami系统经骶棘肌肌间隙入路在APERTURE工具的引导下微创治疗腰椎滑脱症的疗效。方法：20例腰椎滑脱症患者（男11例,女9例）,年龄30～65岁（平均40岁）。其中退变性14例、峡部裂5例、腰椎间盘突出合并钙化1例;Ⅰ度滑脱15例,Ⅱ度滑脱5例。滑脱部位：L4滑脱14例,L5滑脱6例,采用全麻俯卧位下经下腰部正中小切口（5cm）,经双侧骶棘肌肌间隙入路在APERTURE工具的引导下放置Moss Miami系统进行复位固定和椎体间及后外侧植骨融合。结果：本组患者术中在C臂X光机监视,经骶棘间隙放置Moss Miami固定系统简单易行,切口较小、显露好、出血少,对骶棘肌等软组织造成的损伤轻,复位固定效果满意。术后经6月随访表明：本组患者腰腿痛等临床症状缓解,X线片显示滑脱复位无丢失、植骨融合良好、内固定器械无松动及断裂。结论：在C臂X光机监视下,采用Moss Miami经骶棘肌肌间隙入路在APERTURE工具的引导下治疗腰椎滑脱症具有切口小、肌肉软组织损伤轻、出血少、固定器械放置简单易行等优点,有利于患者术后康复。

The Curative Effect of Using Paraspinal Approach to Treat Lumbar Spondylolisthesis with APERTURE Facility

Objective： To evaluate the efficacy of using the paraspinal approach to treat lumbar spondylolisthesis with APERTURE facility.Methods： There were 24 cases of lumbar spondylolisthesis（degreeⅠ 15 cases,degreeⅡ 5 cases）,in which are 11 male and 9 female.The average age at surgery was 40 years（range 35-65）.In these cases,there were 14 degenerative spondylolisthesis,5 isthmus spondylolisthesis,and 1 cases with disc calcify.The site of spondylolisthesis were L4（14 cases） and L5（6 cases）.All cases had used the paraspinal approach to treat lumbar spondylolisthesis with APERTURE facility and Moss Miami pedicel screw.Results： Under x-ray visualization,the operations were excellent,in which the cases were done pass the paraspinal approach with the help of the APERTURE facility.By this way,the incision were mini with little bleeding,and the soft tissue had little injury with good replacement.After 6 month follow up,the cases had excellent result of X-ray.Conclusion： This way,which was done used the paraspinal approach to treat lumbar spondylolisthesis with APERTURE facility had a good result about safety and efficacy without larger injury.