微创经肌间隙入路椎间孔椎体间融合术治疗下腰椎退变性疾病的评价

目的　报道经多裂肌间隙入路椎间孔椎间融合术治疗下腰椎退变性疾患的临床效果。 方法　2010年4月至2012年4月对27例患者经多裂肌间隙入路椎间孔椎间融合术治疗下腰椎退变性疾病。其中男性12例，女性15例，年龄58.2岁（46~74岁）。极外侧型椎间盘突出7例，椎间盘开窗摘除术后复发3例，退变性腰椎不稳17例。 结果　切口长度4.2 cm（4.0~4.5 cm），手术时间90 min（70~160 min），术中出血量130 ml（90~2500 ml）。随访8～20个月，无严重并发症，27例均获骨性融合。末次随访时患者VAS腿痛评分从术前平均(7.4±1.1)分降至(2.4±1.3)分，VAS腰痛评分从术前平均(6.7±1.3)分降至(1.8±1.5)分。临床疗效评定：优22例，良3例，可2例，优良率92.6%。 结论　经多裂肌间隙入路椎间孔椎间融合术具有创伤小、时间短、出血少、并发症少、疗效确切等优点，在合理选择适应证的情况下是一种理想的下腰椎融合方法。

Clinical study of minimally invasive spatium intermuscalare of multifidus for transforaminal lumbar interbody fusion

Objective To explore the clinical outcome of through spatium intermuscalare of multifidus for transforaminallumbar interbody fusion. Methods From April 2010 to April 2012，27 patients underwent screw fixation plus transforaminallumbar interbody fusion through spatium intermusculareof multifidus. There were 12 males and 15 femaleswith the mean age of 58.2 years (range，46~74years). Among them 7 cases hadfar-lateral lumbardisc herniation，3 cases had post-discectomy recurrence，and 17 cases had degenerative instability. Results The average skin incision length was 4.2 cm (range，4.0~4.5 cm)，the average operative time was 90 min(range，70~160 min)，and the average blood loss was 130 ml (range，90~250 m1)．All cases were followed up for 8~20 months (average 13.6 months)．Postoperative radiography showed no evidenceof instrument failure，and all cases got bone fusion．At final followed-up the average leg pain VAS decreased from 7.4±1.1 preoperatively to 2.4±1.3 postoperatively，the averse low back pain VAS decreased from 6.7±1.3 preoperatively to 1.8±1.5 postoperatively． According to Nakai ncriterion，22 cases were rated asexcellent，3 cases as good，and 2 case as fair with the total excellent and good rate of 92.6％. Conclusions Transforaminallumbar interbody fusion through spatium intermusculareof multifidus has some advantages of minimal invasiveness，less blood loss，less complications and reliable curative effect．It is a satisfactory lumbarfusion method undersuitable indication．