微创单侧减压单枚Cage融合治疗退变腰椎间盘突出症的近期疗效

摘要

Objective:To observe the short-term effect of minimally invasive laminectomy and fusion with unilateral pedicle screw and single Cage implantation in the treatment of degenerative lumbar disc herniation.Method:32 cases of degenerative lumbar disc herniation treated with minimally invasive unilateral decompression and fusion with single Cage in our department from October 2008 to June 2012 were involved in this research.The cases included 13 males and 19 females,aged from 52 to 75 years old,with an average of 61.8 years.Protruding sections:L4-5 15 cases, L5-S1 9 cases,L4-5 and L3-4 3 cases, L4-5 and L5-S1 5 cases,among these cases,17 cases associated with spondylolisthesis instability,11 cases associated with nerve root canal stenosis.Nakai evaluation criteria was adopted to evaluate the curative effect of minimally invasive unilateral decompression and interbody fusion with single cage,X-ray and CT images were used to observe whether postoperative intervertebral displacement happen,and the location of pedicle screws and interbody.Result:The operative time was 75-140 minutes,an average of 95 minutes.Blood loss was 180-550 ml,an average of 380 ml.Concurrent dural tear happened in 3 cases,and nerve root traction injury in 2 cases.Follow-up time was 18 months to 3 years and 8 months,lumbar sequence returned to normal after an average of 25 months.Fusion was assessed by Nakai standard 18 months postoperatively,excellent in 23 cases,good in 7 cases,ameliorateve in 2 cases,and the good rate was 93.8%.Interbody fusion rate assessed by Suk standard was 100% at final follow-up time,no asymptomatic recurrence nor loose or shifting of pedicle screws and interbody happened.Conclusion:The short-term effect of minimally invasive unilateral decompression and fusion with single cage in the treatment of degenerative lumbar disc herniation is good,which is well in maintaining responsibility intervertebral height and segmental stability.%目的：观察微创单侧椎板减压椎弓根螺钉内固定加单枚Cage植骨融合治疗退变性腰椎间盘突出症的近期疗效。方法：2008年10月-2012年6月笔者所在科室收治32例退变性腰椎间盘突出症病例。其中男13例，女19例，年龄52~75岁，平均61.8岁。突出节段：L4~515例，L5~S19例，L4~5合并L3~43例，L4~5合并L5~S15例。伴腰椎滑脱不稳17例，神经根管狭窄11例。采用Nakai评定标准判定微创单侧减压加单枚Cage植骨融合术后疗效，X线片和CT影像上观察术后椎体间有无移位，椎弓根螺钉及椎间融合器位置情况。结果：手术时间75~140 min，平均95 min；术中出血180~550 ml，平均380 ml。并发硬脊膜撕裂3例，神经根牵拉伤2例。随访18个月~3年8个月，平均25个月，术后腰椎序列恢复正常；术后18个月时按Nakai标准评定，优23例，良7例，可2例，优良率93.8%；按Suk标准评定椎间融合率为100%；末次随访时无症状复发，椎弓根螺钉及椎间融合器均无松动、移位等。结论：微创单侧减压加单枚Cage植骨融合固定治疗退变性腰椎间盘突出症近期疗效好，能很好地维持责任椎间隙高度和节段稳定。