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椎间盘镜下 B-Twin椎间融合治疗腰椎间盘突出症伴腰椎不稳
引用本文:王博,杨群,张德强,王宏,吴春明,马凯,唐开,刘阳. 椎间盘镜下 B-Twin椎间融合治疗腰椎间盘突出症伴腰椎不稳[J]. 中华骨科杂志, 2011, 31(10): 1110-1115. DOI: 10.3760/cma.j.iaan.0253-2352.2011.10.021
作者姓名:王博  杨群  张德强  王宏  吴春明  马凯  唐开  刘阳
作者单位:116011,大连医科大学附属第一医院脊柱外科
摘    要: 目的 探讨椎间盘镜下减压、B-Twin融合器植骨融合术治疗腰椎间盘突出症伴腰椎不稳的临床疗效。方法 2006年 3月至 2010年 5月, 收治腰椎间盘突出症伴腰椎不稳患者 87例, 男 49例, 女 38例;年龄 37~65岁, 平均 47援6岁。均为单节段病变, L3, 43例、L4, 543例、L5S1 41例。采用单枚 B-Twin椎间融合 51例(单枚组), 双枚融合 36例(双枚组)。采用 Oswestry功能障碍指数(Oswestry disability index, ODI)、疼痛视觉模拟评分(visual analogue scale, VAS)评估患者术后疗效, 并比较两组患者手术时间、出血量、融合时间和椎间隙高度的变化。结果均获得 12~46个月的随访, 平均 35.8个月。术后腰腿痛症状均明显缓解或消失。 ODI术前平均为 78%±3%, 末次随访平均为 18%±3%;VAS评分术前平均为(8.70±1.3)分, 末次随访平均为(0.65±0.48)分;椎间隙高度术前平均为(8.76±1.3) mm, 术后 1个月平均为(12.8±1.5)mm, 术后 12个月平均为(11.8±0.6) mm。单枚组与双枚组 ODI、VAS和椎间隙高度的差异均无统计学意义, 但在手术时间、术中出血量方面的差异均有统计学意义, 单枚组少于双枚组。均获融合或可能融合, 融合时间 3.9~8援6个月, 平均为 5援6个月。结论椎间盘镜下减压、B-Twin融合器植骨融合术治疗腰椎间盘突出症伴腰椎不稳的疗效满意, 单枚与双枚融合疗效相近, 单枚融合具有手术时间短、出血量少、医疗费用低的优点。

关 键 词:腰椎  椎间盘移位  脊柱融合术  外科手术  微创性
收稿时间:2011-07-21;

Posterior lumbar interbody fusion using B-Twin expandable spinal spacer with microendoscopic discectomy for lumbar disc herniation accompanying degenerative instability
WANG Bo,YANG Qun,ZHANG De-qiang,WANG Hong,WU Chun-ming,MA Kai,TANG Kai,LIU Yang. Posterior lumbar interbody fusion using B-Twin expandable spinal spacer with microendoscopic discectomy for lumbar disc herniation accompanying degenerative instability[J]. Chinese Journal of Orthopaedics, 2011, 31(10): 1110-1115. DOI: 10.3760/cma.j.iaan.0253-2352.2011.10.021
Authors:WANG Bo  YANG Qun  ZHANG De-qiang  WANG Hong  WU Chun-ming  MA Kai  TANG Kai  LIU Yang
Affiliation:Department of Orthopaedics, First Hospital of Dalian Medical University, Dalian 116011, China
Abstract:Objective To explore the clinical outcomes of posterior lumbar interbody fusion using BTwin expandable spinal spacer with microendoscopic discectomy (MED) for lumbar disc herniation accompanying degenerative instability.Methods From March 2006 to May 2010,87 patients with lumbar disc heniation (only one level) accompanying degenerative instability were managed with posterior lumbar interbody fusion using B-Twin with MED,includeing 49 males and 38 females with an average of 47.6 years (range,37-65).Objective level located in L3,4 in 2 cases,L4,5 in 43,and L5S1 in 41.The patients were treated with single BTwin (Single group,n=51) and double B-Twin (Double group,n=36).Clinical outcomes were evaluated with surgical time,blood loss,visual analogue scale (VAS) scores,Oswestry disability questionnaire (ODI),and the pre- and post-operative disk space heights.Results The patients were followed up for an average of 35.8months (range,12-46).All the patients felt the low back pain and radiation pain disappeared or relieved apparently.The mean preoperative ODI and VAS scores decreased from 78%±3% to 18%±3%,and (8.70±11.3)to (0.65±10.48) at the final follow-up respectively.Disc space increased from a pre-operative height of (8.76±1.3) mm to a post-operative of (11.8±0.6) mm.ODI,VAS and the disk space heights in all patient showed statistical significance,which revealed no statistical significance between the two groups.However,the operation time,blood loss were statistical difference between the two groups.All the patients achieved solid union or probable union at a mean time of 5.6 months (range,3.9-8.6).Conclusion Posterior lumbar interbody fusion using B-Twin with MED can obtain satisfactory outcomes in the treatment of lumbar disc herniation accompanying degenerative instability.Single B-Twin can get similar clinical outcomes,but shorter surgical time,less blood loss,and less medical costs.
Keywords:Lumbar vertebrae  Intervertebral disk displacement  Spinal fusion  Surgical procedures,minimally invasive
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