多裂肌间隙入路微创手术治疗腰椎滑脱症

Surgical treatment of lumbar spondylolisthesis by minimally invasive transmultifidus approach

中文关键词:  腰椎滑脱  微创  多裂肌间隙  外科手术

英文关键词:Lumbar vertebrae  Spondylolisthesis  Minimally invasive  Surgical procedures

中文摘要:

  【摘要】 目的：探讨经多裂肌间隙入路，微创下椎弓根螺钉固定，椎间植骨融合治疗腰椎滑脱症的临床效果。方法：2006年3月~2009年9月收治95例腰椎滑脱症患者，采用经多裂肌间隙入路微创下行腰椎间植骨融合椎弓根钉内固定术，观察切口长度、手术时间、术中出血量、并发症等情况，影像学观察滑脱角、椎间隙高度、Taillard指数及融合率，采用视觉疼痛模拟评分（Visual analogue scores，VAS）及JOA评分评价临床疗效。结果：手术切口长2.8~3.5cm，平均3.2cm，手术时间80~210min，平均115min，术中出血量120~700ml，平均170ml，术后随访12~42个月，平均25个月，5例出现并发症，其中硬脊膜撕裂1例，术中予以修补，无脑脊液漏；术后足下垂1例，给予神经营养药物，3个月后恢复；下肢疼痛2例，给予非甾体类镇痛药物后症状缓解；切口周围皮肤坏死1例，二期缝合后愈合。术后并发症发生率为5.2%。末次随访矢状面X线片示滑脱角从术前平均6.02°±1.91°减至1.22°±0.70°，椎间隙高度从术前平均（5.06±1.61）mm增至（10.78±0.90）mm，Taillard指数从术前平均26.17±8.50降至8.34±2.35，融合率93.7%。末次随访时VAS腿痛评分从术前平均（7.69±1.61）分降至（2.34±1.60）分，VAS腰痛评分从术前平均（7.15±1.76）分降至（2.15±1.77）分，JOA评分从术前平均（10.09±3.18）分增至（23.14±2.81）分。结论：经多裂肌间隙入路微创治疗腰椎滑脱症对腰椎后部结构破坏小，腰椎滑脱复位及椎间隙高度恢复满意，并发症低、疗效确切，是治疗腰椎滑脱症的理想入路之一。

英文摘要:

  【Abstract】 Objective：To evaluate the method and clinical effect of minimally invasive transmultifidus approach for lumbar spondylolisthesis.Method：From March 2006 to September 2009，95 patients with spondylolisthesis underwent minimally invasive transmultifidus PLIF.After surgery，the skin incision length，operative time，blood loss and complications were analyzed retrospectively.Radiography assessment included the slipping angle，intervertebral disc height，Taillard index and fusion rate.Visual Analogue Scores（VAS）　and JOA scores were used for clinical assessment.Result：The average length of skin incision was 3.2cm（range，2.8 to 3.5cm），the average operative time was 115min（range，80 to 210min），and the average blood loss was 170ml（range，120 to 700ml）.All cases were followed up for 1２~42 months（mean，25 months）.Complications were noted in 5 cases，with 1 case presented with skin atrophy near the incision，which were healed after debridement；dura matter tearing was noted in 1 case，which was resolved after repairing；1 case presented with L5 nerve root deficit which recovered three months later by neuronutrition；2 cases presented with leg pain after operation，which was resolved after administration.The total incidence rate of complications was 5.2%.At final followed-up，the slipping angle decreased from preoperative 6.02±1.91° to postoperative 1.22±0.70°，the intervertebral disc height increased from preoperative（5.06±1.61）mm to postoperative（10.78±0.90）mm，Taillard index decreased from preoperative 26.17±8.50 to postoperative 8.34±2.35.Complete bony fusion was observed in 89 cases，with the fusion rate of 93.7%，and the VAS for leg pain decreased from preoperative 7.69±1.61 to postoperative 2.34±1.60，and VAS for low back pain decreased from preoperative 7.15±1.76 to postoperative 2.15±1.77.The average JOA score increased form preoperative 10.09±3.18 to postoperative 23.14±2.81.Conclusion：Minimally invasive transmultifidus approach for lumbar spondylolisthesis is reliable and less complicationsive.