后路小切口下B-Twin椎间融合术治疗退变性腰椎不稳症

Minimal invasive B-Twin interbody fusion for lumbar degenerative instability

中文关键词:  退变性腰椎不稳症  B-Twin椎间融合器  后路  小切口

英文关键词:Lumbar degenerative instability  B-Twin cages  Posterior approach  Minimal incision

中文摘要:

  【摘要】 目的：探讨后路小切口下B-Twin椎间融合术治疗退变性腰椎不稳症的手术疗效。方法：2006年1月~2008年12月收治退变性腰椎不稳症患者20例，男11例，女9例，年龄33～65岁，平均44岁。腰椎前屈后伸侧位X线片显示所有患者存在腰椎不稳，其中L4/5 12例，L5/S1 8例。MRI显示不稳节段合并中央型椎间盘突出9例，侧方椎间盘突出11例；同时合并腰椎管狭窄15例，其中侧隐窝狭窄11例，中央型椎管狭窄4例。均采用后路小切口下椎间盘切除、神经根管探查减压和B-Twin椎间融合术。结果：手术时间为1.3～2.3h，平均1.8h；术中出血量为70～90ml，平均80.7ml。术中无硬脊膜损伤，术后无脑脊液漏、神经功能损伤、伤口血肿等并发症发生。失访1例，19例随访6个月～2.5年，平均1.3年。患者术前Oswestery功能障碍指数（ODI）评分为38.74±4.70分，术后第3天为12.26±2.18分，术后3个月为9.95±2.39分，末次随访为8.05±2.07分，术后各时间点与术前比较P<0.01，术后3个月与术后第3天比较P<0.05，末次随访时与术后3个月比较P＞0.05。术前病变椎间隙高度为9.73±1.49mm，术后第3天为13.53±1.63mm，末次随访为12.32±1.42mm，术后各时间点与术前比较P<0.01，末次随访与术后第3天比较P<0.05。10例融合器出现2mm以内沉陷，5例出现较明显沉陷（＞2mm），无融合器脱落。18例患者植骨融合，1例未融合但无任何临床症状。2例仍有腿部疼痛，1例予保守治疗后好转，1例为骨粒脱落所致未进一步治疗。结论：后路小切口下B-Twin椎间融合术治疗退变性腰椎不稳症的创伤较小、安全性较高、近期效果较好。

英文摘要:

  【Abstract】 Objective：To explore the effect of minimal invasive B-Twin interbody fusion for lumbar degenerative instability.Method：From Jan 2006 to Dec 2008，20 cases suffering from lumbar degenerative instability（11 males and 9 females） underwent posterior discectomy，decompression and B-Twin interbody fusion under minimal invasive procedure.The sample had average age of 44 years old（range，33 to 65 years）.Preoperative lumbar dynamic X-ray showed instability in all cases, of these，12 in L4/5 and 8 in L5/S1.MRI showed central disc prolapse in 9 cases and lateral disc prolapse in 11，Lumbar spinal stenosis was noted in 15 cases，of those，11 cases had lateral recess stenosis and 4 had central canal stenosis.Result：The operation time ranged from 1.3h to 2.3h（average，1.8h）.The blood loss ranged from 70ml to 90ml（average，80.7ml）.No injury to dural matter and cerebrospinal fluid leakage was noted，neurological injury and incision hematoma were not noticed either.1 case was lost follow-up and 19 cases were followed up for an average of 1.3 years（range，6 months to 2.5 years）.The ODI score for preoperative，3 days，3 months and final follow-up was 38.74±4.70，12.26±2.18，9.95±2.39，8.05±2.07 respectively（postoperative compare to preoperative，P<0.01；3 months compare to 3 days postoperative，P<0.05；3 months compared to final follow-up，P＞0.05）.The disc height in preoperative，3 days postoperative and final follow-up were 9.73±1.49mm，13.53±1.63mm and 12.32±1.42mm respectively（postoperative compare to preoperative，P<0.01；3 days postoperative compare to final follow-up，P<0.05）.More than 2mm subsidence of B-Twin was presented in 5 cases and less than 2mm subsidence in 10 cases.Bony nonunion occurred in 1 case and 18 cases had solid bony union.2 cases had some extent of leg pain after operation and among them，1 had pain relieved after conservative treatment and 1 still had pain unresolved due to prolapsed bone graft.Conclusion：Minimal invasive B-Twin interbody fusion for lumbar degenerative instability is reliable and less invasive, which can ensure a good short term outcome.