旁正中入路单侧固定椎间融合治疗腰椎退行性疾病

目的探讨旁正中入路单侧固定结合经椎间孔椎体间融合(TLIF)治疗腰椎退行性疾病的临床疗效。方法采用旁正中入路小切口单侧椎弓根螺钉内固定结合TLIF治疗35例腰椎退行性疾病患者。记录手术时间、出血量及切口长度;于术前、术后3个月及末次随访时对患者行疼痛视觉模拟评分(VAS)与Oswestry功能障碍指数(ODI)评定;其中16例术后复查腰椎MRI,比较手术间隙水平多裂肌横截面积的变化。结果 35例患者均顺利完成手术。手术时间85~125(105±14)min;术中出血量120~350(175±75)ml;切口长度3.5~5.0(4.2±0.6)cm,切口均一期愈合。未发生硬脊膜撕裂、神经根损伤及深部感染等并发症。35例均获随访,时间12~40(23±9.5)个月。无椎弓根螺钉断裂、松动及椎间融合器移位等内置物失败发生。术后及随访期间腰腿痛VAS评分和ODI与术前比较均明显改善(P0.05)。术后MRI测量多裂肌的横截面积与术前比较无明显减小(P0.05),并未见明显的椎旁肌纤维化。结论旁正中入路小切口单侧椎弓根螺钉固定结合TLIF手术具有创伤小、出血少、恢复快、多裂肌萎缩和腰背痛发生率低等优点,在合理选择手术适应证的情况下可取得良好的临床疗效。

Unilateral pedicle screw fixation with transforaminal lumbar interbody fusion by paraspinal approach in the treatment of lumbar degenerative diseases

Objective To explore the clinical efficacy of unilateral pedicle screw fixation with transforaminal lumbar interbody fualon（TLIF） by paraspinal approach in the treatment of lumbar degenerative diseases. Methods 35 pa-tients with lumbar degenerative diseases underwent unilateral pedicle screw fixation with TLIF by paraspinal ap-proach. The operation time, blood loss, and length of incision were recorded and analyzed. The visual analog scale （VAS） score, and Oswestry disability index（ODi） were used to assess clinical outcomes. 16 patients accepted MRI evaluation by compare the cross sectional area of multifidus at the operative level between pre-operation and post-oper-ation. Results The operation of 35 patients was successful, there were no severe complication. The operative time was 85 ～ 125（105 ± 14） min, the blood loss was 120 ～350 （175 ±75） nil, the length of incision was 3.5 ～ 5.0 （4. 2 ± 0.6） cm. Primary healing of incision was obtained in all cases, no injury of nerve root, dural tear, or deep in-fection occurred. The patients were followed up for 12 ～40 （23 ±9.5） months. No pedicle screw loosening, break ing, or intervertebral fusion cage pulling out were observed. The symptoms were obviously improved in all patients af-ter operation. The VAS score and ODI at 3 months and last follow up showed significant differences compared with preoperative ones （P 〈 0. 05）. No muscucar fibrosis was found. The cross sectional area of multifidus at the operative level was not obviously changed between pre operation and post operation （ P 〉 0. 05 ）. Conclusions The surgical procedure of unilateral pedicle screw fixation with transforaminal lumbar interbody fusion by paraspinal approach has advantages including less invasion, less blood loss, quickly recovery, and less incidence of mutifidus atrophy and low back pain, and the clinical efficacy is satisfactory under suitable indication.