摘要
目的探讨退变性腰椎管狭窄症的微创治疗策略。方法回顾性分析2008年3月至2010年8月采用微创手术治疗的73例腰椎管狭窄症患者，根据患者的临床、影像学表现及是否合并其它脊柱疾病进行分类，对不同类型病变采取不同的微创手术方式，分别统计手术时间、出血量、手术并发症及术前、术后6个月和末次随访时日本矫形外科学会（Japanese Orthopaedic Association，JOA）评分及Oswestry功能障碍指数（Oswestry disability index，ODI），根据JOA评价标准对手术疗效进行评价。结果73例微创手术均顺利完成。25例患者采用双侧减压方法，48例患者采用单侧人路潜行双侧减压；23例患者在减压的同时进行椎间融合加经皮内固定手术。手术时间、术中出血量与减压方式及是否行椎间融合内固定相关。术中硬膜曩撕裂1例；1例骨质疏松患者行椎问融合时融合器打入上位椎体中，取出融合器，予椎体间植骨融合；术后出现切口愈合不良3例，考虑与术中微创可扩张通道撑开过紧有关，予抗炎及换药后切口愈合。术后随访10-35个月，平均13个月。患者术前及术后6个月的JOA评分和ODI明显改善，差异有统计学意义（P〈0．01）。23例行椎间融合及内固定患者，22例患者获得满意融合，无螺钉断裂及松动发生。结论微创手术治疗腰椎管狭窄症疗效肯定，但应根据腰椎管狭窄症患者的临床、影像学表现、合并疾患及术者的临床经验和医院的具体条件来选择合适的手术方式。
Objective To explore the ideal minimally invasive surgical method for degenerative lumbar spine stenosis. Methods From March 2008 to August 2010, 73 cases with lumbar spinal stenosis underwent minimal invasive surgery were retrospectively analyzed. The patients were divided into different groups by clinical features, imaging manifestations, and concurrent diseases. The minimal invasive surgical methods were chosen according to the classification. Operation time, intra-operative bleeding, and complica- tions were recorded. The lumbar function was evaluated by Oswestry disability index （ODI）, and the clinical results were assessed by JOA pre- and postoperatively. Results Minimal invasive surgery was completed in all cases, which included 25 cases with bilateral decompression and 48 cases with unilateral approach for bilateral decompression. Twenty-three cases used interbody fusion and percutaneous pedicle screw fixation after decompression. Intraoperative blood loss and operation time were related to surgical methods. One case was complicated with dural tear. Cage was inserted into upper vertebral body during interbody fusion in 1 case with osteoporosis, removed the cage and implanted bone fusion. Incisions of 3 cases were poor healing after surgery. The average follow up time was 13 months （range, 10-35）. JOA score and ODI before surgery were 9.2±5.1 and 62.3%±18.5% respectively; while 6 months after surgery, JOA score and ODI were 23.5± 7.2 and 18.4%±6.4% respectively. JOA score and ODI showed statistically significant improvements after op- eration （P〈0.01）. Twenty-two cases got solid fusion at the final follow-up. Conclusion Treatment of lumbar spinal stenosis by minimal invasive surgery has satisfactory surgical outcomes, but the proper minimal inva- sire strategy should be chosen according to specific patients, surgeons and hospitals.
出处
《中华骨科杂志》
CAS
CSCD
北大核心
2011年第10期1099-1103,共5页
Chinese Journal of Orthopaedics
关键词
外科手术
微创性
腰椎
椎管狭窄
Surgical procedures, minimally invasive
Lumbar vertebrae
Spinal stenosis
