微创通道下肌间隙入路内固定融合术治疗巨大型腰椎椎间盘突出症

目的 探讨微创通道下肌间隙入路单侧椎弓根螺钉联合对侧椎板关节突螺钉内固定并椎间融合术治疗巨大型腰椎椎间盘突出症(LDH)的可行性.方法 回顾性分析2012年6月—2017年12月收治的47例巨大型LDH患者临床资料,均采用单侧椎弓根螺钉联合对侧椎板关节突螺钉内固定并椎间植骨融合术治疗,其中采用正中切口入路22例(正中切...

Minimally invasive internal fixation and fusion via intermuscular approach for giant lumbar disc herniation

Objective To investigate the feasibility of minimally invasive unilateral pedicle screw combined with contralateral translaminar facet screw internal fixation and interbody fusion via intermuscular approach for giant lumbar disc herniation(LDH).Methods The clinical data of 47 patients with giant LDH from June 2012 to December 2017 were analyzed retrospectively.All the patients were treated with unilateral pedicle screw combined with contralateral translaminar facet screw internal fixation and interbody fusion,including 22 cases via median incision approach(median incision group),and 25 cases via minimally invasive intermuscular approach through minimally invasive channel(intermuscular group).The perioperative indexes,imaging parameters,visual analogue scale(VAS)score,Japanese Orthopaedic Association(JOA)score and complications were observed and compared between the 2 groups.Results All the operations were successfully completed without incision infection,and there was no significant difference in operation time between the 2 groups(P>0.05).All the patients were followed up for 12-48(26.50±7.45)months.Compared with the median incision group,the intermuscular group had shorter incision length,less intraoperative blood loss,less postoperative drainage volume and lower VAS score of lumbar incision pain 72 h after operation,and the differences were statistically significant(P<0.05).There was no significant difference between the 2 groups in the rate of pedicle screw misplacment(P>0.05),but the rate of translaminar facet screw misplacment in the intermuscular group was significant higher than that in the median incision group(P<0.05).The intervertebral space height in both groups recovered significantly after operation,but lost at the final follow-up compared with that at posteperative 3-5 d,and the differences were statistically significant(P<0.05).There was no significant difference in the intervertebral space height between the 2 groups at each time point(P>0.05).The coronal plane and sagittal plane balance of lumbar was improved in both groups at the final follow-up.At postoperative 12 months,the area and grade of multifidus were significantly better in the intermuscular group than in the median incision group(P<0.05).During the follow-up,no screw loosening,breakage and cage displacement were observed.The fusion rate was 95.5%in the median incision group and 92.0%in the intermuscular group,and there was no statistical difference between the 2 groups(P>0.05).The JOA scores were significantly improved at the final follow-up in 2 groups,but the differences were not statistically significant between the 2 groups(P>0.05).The incidence of complications was 13.6%(3/22)in the median incision group and 20.0%(5/25)in the intermuscular group,and the difference was statistically significant(P<0.05).Conclusion Minimally invasive unilateral pedicle screw combined with contralateral translaminar facet screw internal fixation and interbody fusion via intermuscular approach for the treatment of giant LDH is clinically feasible.Compared with the median incision approach,it has the advantages of small incision,less trauma,less blood loss,faster postoperative recovery,but steep learning curve and higher incidence of early complications.