后路内窥镜下椎间盘切除单枚B-Twin融合器植骨融合治疗腰椎间盘突出症

Microendoscopic discectomy with single B-Twin implantation for lumbar disc herniation

中文关键词:  椎间盘突出症  脊柱融合术  内窥镜  B-Twin融合器

英文关键词:Lumbar disc herniation  Spine fusion  Microendoscopic discectomy  B-Twin

中文摘要:

  【摘要】　目的：观察后路内窥镜下椎间盘切除减压、单枚B-Twin融合器椎间植骨融合治疗腰椎间盘突出症的效果。方法：2005年6月至2008年6月收治腰椎间盘突出症患者21例，其中17例伴腰椎不稳。均有腰痛伴单侧下肢痛。均为单节段病变，其中L3/4 1例，L4/5 12例，L5/S1 8例。术前椎间隙高度7.73±1.61mm；Oswestry功能障碍指数（ODI）为31~45分，平均37.5±6.9分。均行后路内窥镜下椎间盘切除减压、单枚B-Twin 融合器椎间植骨融合术。随访患者临床症状改善情况，术后1个月、末次随访时进行ODI评分，并行影像学检查观察融合器位置、椎间隙高度和植骨融合情况。结果：手术时间1.5～2.1h，平均1.7h；术中出血量75～190ml，平均90ml。术中无神经和血管损伤等并发症。21例均获随访，随访时间6个月～3年，无感染、血肿、神经功能损伤及融合器脱落等并发症。术后1个月ODI为10~19分，平均（15.5±4.2）分，与术前比较有显著性差异（P<0.01），末次随访时ODI为7~12分，平均（9.6±3.8）分，与术后1个月比较有显著性差异（P<0.01）。术后1个月椎间隙高度为10.23±1.49mm，与术前比较有显著性差异（P<0.01），末次随访时为7.75±1.74mm，与术前比较无著性差异（P>0.05），与术后1个月比较差异有显著性差异（P<0.01）；椎间融合器位置良好，植骨均融合。结论：后路内窥镜下椎间盘切除减压、单枚B-Twin融合器椎间植骨融合治疗腰椎间盘突出症伴腰椎不稳或术后可能发生不稳的患者创伤小、效果好。

英文摘要:

  【Abstract】 Objective：To investigate the clinical effect of microendoscopic discectomy（MED） with single B-Twin implantation for lumbar disc herniation.Method：21 cases with lumbar intervertebral disc herniation undergoing posterior MED with single B-Twin implantation between June 2005 and June 2008 were reviewed retrospectively.All patients complained of lower back pain and unilateral lower limbs pain.The involved levels included L3/4 in 1 patient，L4/5 in 12 patients and L5/S1 in 8 patients.The preoperative disc height was 7.73±1.61mm，the degree of instability scored by the Oswestry disability index（ODI） was 31-45（37.5±6.9）.The ODI score and disc height at 1 month after operation and the latest follow-up together with instrument displacement and bony union were reviewed.Result：The mean duration of operation was 1.7h（1.5-2.1h） with blood loss of 75-190ml（mean，90ml）.No neurovascular complications were noted.All 21 patients were followed-up from 6 months to 3 years and no severe complications such as deep infection，hematoma，nerve injury and instrument displacement were found.The ODI score at 1 month postoperatively was 10-19（mean 15.5±4.2），which showed significant difference compared with that of preoperative（P<0.01），the ODI score at final follow-up was 7-12（mean 9.6±3.8），which showed significant difference as compared with the 1 month postoperative counterpart（P<0.01）.The one month postoperative disc height was 10.23±1.49mm，with significant difference compared with the preoperative one（P<0.01），and the finalt follow-up dissc height was 7.75±1.74mm，with significant difference compared with the 1 month postoperative one（P<0.01），but no significant difference was noted as compared to the preoperative one（P＞0.05）.All the patients achieved solid bony union without instrument displacement at final follow-up.Conclusion：MED with single B-Twin implantation for lumbar disc herniation is reliable and minimal invasive.