摘要
目的探讨经皮内窥镜下椎间盘摘除B-Twin可膨胀椎间融合器治疗退行性腰骶椎疾病的临床效果。方法回顾性分析2007年1月-2008年8月应用经皮内窥镜下椎间盘摘除B-Twin可膨胀椎间融合器椎间融合的方法治疗21例退变性腰骶椎疾病患者临床资料。其中男13例,女8例;年龄28～79岁,平均52岁。病程3个月～40年,中位时间9个月。病变部位:T11、12 1例,T12、L1 1例,L1、2 1例,L2、3 1例,L4、54例,L5、S1 13例。所有患者均有顽固性腰痛或下肢神经根性症状。B-Twin可膨胀椎间融合器植入的方法为15例双侧,6例单侧。应用Oswestry功能障碍指数(ODI)和改良Macnab法评价功能恢复情况;根据X线片采用Suk等标准评价植骨融合效果。结果 21例均获随访,随访时间18个月～3年,平均23.8个月。术后19例坐骨神经痛症状消失,2例胸腰段病变患者症状无明显缓解。术前及术后1、3、6、18个月ODI分别为79%±16%、30%±9%、26%±10%、21%±12%、20%±10%,术后各时间点与术前比较差异均有统计学意义(P<0.05)。术后6个月采用改良Macnab法评价,获优14例、良5例、可2例,优良率为90.5%。术后18个月根据Suk等标准评价植骨融合情况,获优1例,良19例,差1例,优良率95.2%。其中,1例T11、12椎间盘突出患者术后双下肢肌力无改善,6个月后行椎弓根固定、椎板切除减压,随访期内仍无改善;1例L4、5椎间盘突出于术后4个月复发,改行椎板开窗髓核摘除,随访期内无复发;其余患者术后临床症状均获持续缓解。结论内窥镜结合椎间融合是治疗腰椎不稳的良好组合,B-Twin可膨胀椎间融合器是L4、5和L5、S1微创融合的一种选择。
Objective To investigate the effectiveness and significance of percutaneous endoscopic discectomy followed by interbody fusion using B-Twin expandable spinal spacer for degenerative lumbosacral disc disease.Methods Between January 2007 and August 2008,21 patients with degenerative lumbosacral disc disease were treated with endoscopic discectomy followed by interbody fusion using B-Twin expandable spinal spacer.Among them,there were 13 males and 8 females with an average age of 52 years（range,28-79 years）.And the disease duration ranged from 3 months to 40 years（median,9 months）.The affected segments included T11,12,T12-L1,L1,2,and L2,3 in 1 case respectively,L4,5 in 4 cases,and L5,S1 in 13 cases.All patients had intractable low back pain or lower extremity radicular symptoms.The placement methods of B-Twin expandable spinal spacer were double sides in 15 cases and single side in 6 cases.Oswestry Disability Index（ODI） and Macnab grading were used to determine the function recovery after operation.And Suk＇s standard was used to determine the fusion effects by X-ray.Results All 21 patients were followed up 18 months to 3 years（mean,23.8 months）.Sciatica symptoms disappeared after operation in 19 cases,no significant improvement occurred in 2 cases of thoracic disease.The ODI scores were 79% ± 16% at preoperation,30% ± 9% at 1 month,26% ± 10% at 3 months,21% ± 12% at 6 months,and 20% ± 10% at 18 months after operation,showing significant differences between pre-and postoperation（P〈 0.05）.According to Macnab grading at 6 months postoperatively,the results were excellent in 14 cases,good in 5 cases,and fair in 2 cases with an excellent and good rate of 90.5%.According to Suk et al.standard,the results were excellent in 1 case,good in 19 cases,and poor in 1 case with an excellent and good rate of 95.2%.The muscle strength of the lower extremities had no improvement in 1 case of T11,12 disc protrusion;pedicle screws fixation and decompression laminectomy were given after 6 months,but no improvement was achieved during follow-up.Protrusion recurred after 4 months in 1 case of L4,5 disc protrusion,then was cured by laminectomy discectomy.The remaining patients achieved postoperative relief.Conclusion Endoscope combined with interbody fusion is a good combination to solve lumbar instability.B-Twin expandable spinal spacer is a minimally invasive fusion choice of L4,5 and L5,S1.
出处
《中国修复重建外科杂志》
CAS
CSCD
北大核心
2011年第10期1153-1157,共5页
Chinese Journal of Reparative and Reconstructive Surgery
