腰椎动态植入物内固定系统治疗腰椎间盘突出症的早期疗效

背景：目前，对保守治疗无效的椎间盘突出症常用方法是经后正中入路髓核摘除、神经根管减压和刚性融合内固定，由此引起相邻节段的退变和腰椎生理活动受限是临床所面对的问题；而非融合固定的传统后正中入路则由于存在切口大、剥离广、腰背肌的失神经支配等缺点。 目的：观察经Wiltse入路腰椎动态稳定植入物内固定系统治疗腰椎间盘突出症的疗效，并与传统后方入路的疗效进行比较。 方法：纳入因腰椎间盘突出症于2011年1月到2013年1月分别在武汉大学人民医院行腰椎间盘摘除＋腰椎动态稳定系统固定的患者46例，其中经传统后方入路25例，Wiltse入路21例。 结果与结论：46例患者均获得随访，随访时间7-31个月，平均（13.8±2.4）个月。Wilste入路组患者切口长度、内固定中失血和内固定后引流均低于传统后方入路组（P〈0.05）；但2组患者内固定后1周和6个月目测类比评分与手术时间比较差异无显著性意义（P〉0.05）。X射线显示所有患者内固定物位置良好，无松动或断裂。提示Wiltse入路腰椎动态植入物内固定系统治疗腰椎间盘突出的早期疗效与传统后方入路接近。

Early effect of lumbar dynamic fixation for treatment of lumbar disc herniation

BACKGROUND：Currently, one of common methods is discectomy, nerve root decompression and fusion rigid fixation from the midline approach for disc herniation which is inefficient by conservative treatments. Thus, it is causing degeneration and limiting lumbar physiological activity of adjacent segments. The treatment of non-fusion lumbar disc herniation with the traditional posterior midline incision approach has some disadvantages such as big incision, wide peeling, and back muscle denervation. 〈br〉 OBJECTIVE：To observe therapeutic effects of dynamic stabilization system through Wiltse approach on lumbar disc herniation, and to compare the outcomes with traditional posterior approach. 〈br〉 METHODA total of 46 patients, who had undergone discectomy and internal fixation using dynamic stabilization systems for lumbar disc herniation at the Renmin Hospital of Wuhan University from January 2011 to January 2013, were enrol ed in this study. The operation was performed through the traditional posterior approach in 25 patients and Wiltse approach in 21 patients. 〈br〉 RESULTS AND CONCLUSION：Al 46 patients were fol owed up for 7 to 31 months （averagely, 13.8±2.4 months）. The length of incision, intraoperative blood loss, and postoperative drainage amount were less in the Wiltse approach group than in the traditional posterior approach group （P〈0.05）. No significant difference in visual analog scale scores and operative time was detected between the two groups at 1 week and 6 months after fixation （P〉0.05）. Radiographs revealed that the position of implants was good in al patients, no loosing or breakage. These data verified that the early effect of dynamic stabilization system through Wiltse approach for lumbar disc herniation is similar to that of traditional posterior approach.