经改良wiltse微创入路并自制拉钩行椎弓根螺钉固定融合术治疗腰椎滑脱症

摘要

Objective To analyze clinical effect and safety of pedicle screw fixation and fusion by improving wiltse mini-invasive approach and self-made retractor in treatment of lumbar spondylolisthesis.Methods A total of 24 patients with lumbar spondylolisthesis underwent pedicle screw fixation and fusion by improving wiltse mini-invasive approach and self-made retractor during January 2013 and December 2015, and all patients were followed up for 3-18 months.Intraoperative blood loss volume, operative time and improvement rate of treatment were observed, and changes of slip angle, slip percentage, visual analogue scales (VAS) score and Japanese Orthopaedic Association (JOA) score were compared before operation and at the last time of follow-up.Results All patients underwent operation successfully, and the operative time was(145±24.40) min, and intraoperative volume of blood loss was (167.50±70.88) ml.There were no complications such as blood transfusions, cerebrospinal leak and nerve roots damage with 3-18 months of follow-up.There were significant differences in visual analogue scales (VAS) and Japanese orthopaedic association (JOA) in the last time follow-up compared with those before operation (P<0.05).There were 18 patients with excellent, 4 patients with good and 2 patients with common, and the good and excellent rate was 91.7％.Conclusion Pedicle screw fixation and fusion by improved wiltse mini-invasive approach and self-made retractor in treatment of lumbar spondylolisthesis can achieve minimal trauma, good clinical effect and safety.%目的 探讨经改良wiltse微创入路并自制拉钩行椎弓根螺钉固定融合术治疗腰椎滑脱症的临床效果及安全性.方法 选择我院2013年1月-2015年12月收治的腰椎滑脱症24例,均采用改良wiltse微创入路并自制拉钩行椎弓根螺钉固定融合术,术后随访3～18个月.观察术中出血量、手术时间及治疗改善率,比较术前及末次随访滑脱角、滑脱率、视觉模拟(VAS)评分和日本骨科协会评估治疗(JOA)评分变化.结果 本组均顺利完成手术,手术时间(145±24.40)min,术中出血量(167.50±70.88)ml,均无输血支持,无脑脊液漏、神经根损伤等并发症.随访3～18个月.与术前比较,末次随访VAS评分及JOA评分差异均有统计学意义(P<0.05).临床疗效优18例,良4例,一般2例,优良率91.7％.结论 经改良wiltse微创入路并自制拉钩行椎弓根螺钉固定融合术治疗腰椎滑脱症创伤小,临床疗效及安全性好.