显微内窥镜下椎管减压椎间融合治疗腰椎失稳症的近期疗效观察

Short term outcome of microendoscopic decompression and interbody fusion for degenerative lumbar instability

中文关键词:  腰椎失稳  显微内窥镜  手术

英文关键词:Lumbar instability syndrome  Microendoscopy  Operation

中文摘要:

  【摘要】 目的：探讨显微内窥镜下椎管减压、椎间植骨融合治疗腰椎失稳症的临床疗效。方法：2006年7月～2008年12月共收治退变性腰椎失稳症患者48例，患者均有持续性腰痛，伴有双侧臀部、双侧或一侧下肢疼痛、麻木，均有间歇性跛行、腰部屈伸活动受限。腰椎动力位X线片示均为单节段失稳，椎间水平移位≥4mm或椎间角度变化≥11°，但滑移不超过Ⅰ度。均采用显微内窥镜下经椎板间隙入路椎管减压、经椎间孔入路椎体间自体骨粒、椎间融合器置入椎体间融合术。术后2周（出院时）拍腰椎正侧位X线片，术后每3个月复查X线片。按照Macnab标准评价疗效，随访观察近期治疗效果。结果：手术时间70～150min，平均95min；出血量110～210ml，平均150ml。随访6～18个月，平均12个月。术后症状及体征均有不同程度缓解，术中、术后均无任何并发症发生。末次随访时按照Macnab标准，优24例，良20例，可4例。X线检查未见cage移位、下沉，37例随访超过9个月的患者均见椎间隙变模糊，过伸过屈侧位X线片示椎体间无移位，但所有患者均未观察到椎间隙消失和骨小梁完全通过椎体间上下终板。结论：显微内窥镜下椎管减压及椎间融合术治疗退变性椎间失稳症具有创伤小、早期疗效满意等优点，长期疗效及融合情况需进一步随访观察。

英文摘要:

  【Abstract】 Objective：To investigate the clinical efficacy of microendoscopic decompression and interbody fusion for degenerative lumbar instability.Method：From July 2006 to December 2008，48 patients with degenerative lumbar instability syndrome underwent microendoscopic translamilar decompression and transforaminal fusion.All the patients presented with persistent low back pain accomplied by bilateral or unilateral numbness，pain，intermittent claudification and limitation of lumbar spine ROM.All patients had single segment instability on dynamic radiography，with the translational motion over 4mm or angular variation over 11°，patients with slippage over Ⅰ degree were excluded.X-ray was performed at 2 weeks and every 3 months after the operation.The clinical short term outcome were assessed by Macnab criteria.Result：The operative time was 70-150 minutes（mean，95 minutes），with the blood loss of 110-210ml（mean，150ml）.All cases experienced surgery successfully and were followed up for a period of 6-18 months（mean，12 months）.No complication was noted in any case.24 cases was rated excellent，20 good and 4 fair according to the Macnab criteria.No cage displacement and subsidence was noted.37 cases followed up for more than 9 months had trabecula bone formation across disc space，vertebral displacement was not evidenced on dynamic radiograph，however complete disc space disappear and trabecula bone bridging between endplate was not seen in all cases.Conclusion：Microendoscopic decompression and interbody fusion is minimal invasive and reliable，however its long term outcome need to be determined.