经骶前间隙轴向椎间融合联合内窥镜下后入路椎间盘摘除治疗腰骶椎退行性疾病

Axial lumbar interbody fusion(AxiaLIF) plus posterior microendoscopic lumbar discectomy for lumbosacral degenerative diseases

中文关键词:  轴向椎间融合术  内窥镜  椎间盘摘除  腰骶椎退行性疾病

英文关键词:Axial lumbar interbody fusion  Microendoscopic  Lumbar discectomy  Lumbosacral degenerative diseases

中文摘要:

  【摘要】 目的：探讨采用经骶前间隙轴向椎间融合（axial lumbar interbody fusion，AxiaLIF）联合显微内窥镜下后入路椎间盘摘除治疗腰骶椎退行性疾病的临床效果。方法：2010年3月~2012年3月共收治腰骶椎退行性疾病患者23例，其中男13例，女10例；年龄36～59岁，平均45岁。病变累及L5/S1节段17例，L4/5与L5/S1双节段6例，所有患者均表现为腰痛及单侧下肢神经根性症状。均采用经骶前间隙轴向椎间融合联合显微内窥镜下后入路椎间盘摘除术治疗。观察手术时间、术中出血量及并发症发生情况，影像学复查观察植骨融合情况，以视觉疼痛模拟评分（VAS）和JOA评分评估临床效果。结果：手术时间90～170min，平均130min；术中出血50～160ml，平均80ml。1例患者术后出现骶前血肿，予以伤口局部换药、引流1周后血肿吸收。全部病例随访6～24个月，平均16.5个月。术后6个月时椎体植骨融合率82.6％，4例患者术后骨融合时间延迟，至术后12个月随访时均已获得坚强融合，其余患者无内固定等相关并发症发生。术前及末次随访腰痛VAS评分分别为7.19±1.04分、0.69±0.58分，腿痛VAS评分分别为7.27±1.96分、0.87±0.49分，JOA评分分别为13.01±2.03分、26.62±1.25分，末次随访时均较术前明显改善（P＜0.05）。结论：经骶前间隙轴向椎间融合联合显微内窥镜下后入路椎间盘摘除治疗腰骶椎退行性疾病对腰椎结构破坏小，出血少，并发症发生率低，近期手术效果好，是一种治疗腰骶椎退行性疾病的有效方法。

英文摘要:

  【Abstract】 Objectives: To evaluate the clinical outcomes of axial lumbar interbody fusion(AxiaLIF) plus posterior microendoscopic lumbar discectomy for lumbosacral degenerative diseases. Methods: From March 2010 to March 2012, 23 cases suffering from lumbosacral degenerative diseases and undergoing axial lumbar interbody fusion and microendoscopic lumbar discectomy were reviewed retrospectively. There were 13 males and 10 females with the age at time of surgery ranging from 39 to 59 years(mean, 45 years). There were 17 with L5/S1 segment involved, 6 with L4/5 and L5/S1 segment involved. The operation time, blood loss and complications were recorded． Fusion rate was observed． Visual analogue scale(VAS) and Japanese Orthopaedic Association(JOA) scores were used for clinical assessment． Results: The average operation time was 130min(range, 90-170min) and the average intraoperative blood loss was 80ml(range, 50-160ml) in 23 patients． All case were followed up from 6 to 24 months(average, 16.5 months). During follow-up, one patient developed presacral hematoma at the day after operation, while after local dressing and drainage for one week, the hematoma was absorbed. The fusion rate of bone graft body was 82.6% at 6 months of follow-up, 4 cases of postoperative bone fusion time delay, incomplete bony fusion was shown after 12 months of follow-up. There were no other complications occurred else. The VAS score of low back pain for preoperative and final follow-up was 7.19±1.04 and 0.69±0.58 respectively. The VAS score of leg pain for preoperative and final follow-up was 7.27±1.96 and 0.87±0.49 respectively. The JOA score for preoperative and final follow-up was 13.01±2.03 and 26.62±1.25 respectively. Conclusions: Axial lumbar interbody fusion and microendoscopic lumbar discectomy is an effective method for degenerative lumbosacral diseases due to its minimal invasive to the posterior stucture, less intraoperative blood loss and low incidence of complications．