目的 探讨Zista通道下微创减压融合内固定术治疗双及三节段腰椎管狭窄症的临床效果.方法 回顾性收集2016年4月至2017年10月手术治疗双及三节段腰椎管狭窄症患者45例的病历资料,男21例,女24例;年龄50～74岁,平均(62.5±11.2)岁.按手术方式分为微创组和开放组.微创组采用Zista通道下微创减压椎间融合内固定术治疗,共19例,双节段14例,三节段5例;开放组采用传统开放手术治疗,共26例,双节段17例,三节段9例.采用日本骨科学会(Japanese Orthopaedic Association,JOA)评分(29分法)及疼痛视觉模拟评分(visual analogue scale,VAS)评价疗效,并测量手术前后微创组侧隐窝角度变化以评估减压效果,末次随访时采用MacNab标准评估临床疗效.结果 所有患者均顺利完成手术.微创组双节段手术时间230～310 min,平均(240±15)min;三节段手术时间320～370 min,平均(320±15)min.开放组双节段手术时间210～300 min,平均(255±15)min;三节段手术时间330～390 min,平均(315±20)min.微创组和开放组手术时间的差异无统计学意义.微创组双节段患者术中出血量190～310 ml,平均(220±25)ml;三节段术中出血量280～410 ml,平均(340±30)ml.开放组双节段患者术中出血量500～730 ml,平均(550±25)ml;三节段术中出血量750～920 ml,平均(840±20)ml.开放组患者术中出血量明显多于微创组.所有患者均获得随访,微创组3～12个月,平均(7.3±3.2)个月;开放组3～12个月,平均(8.1±2.6)个月.两组患者术后3个月腰痛及下肢痛VAS评分较术前平均降低4.2分和5.4分(微创组)以及4.7分和5.1分(开放组),术后3个月JOA评分较术前平均增加13.3分(微创组)以及12.7分(开放组),两组双节段及三节段的患者术后3个月疼痛VAS评分和JOA评分均明显优于术前.通道组术后3个月骨性侧隐窝角和软性侧隐窝角分别较术前增加16.64°和15.48°,椎管狭窄情况得到明显改善.所有患者均未出现切口感染、硬膜破裂、脑脊液漏、内植物松动等不良事件.结论 Zista通道下微创减压椎间融合内固定术治疗腰椎管狭窄症具有手术时间短、术中出血少及术后感染率低等优点,是微创治疗腰椎管狭窄症的有效手段.%Objective To evaluate the clinical efficacy of the minimally invasive treatment with Zista system for lum-bar spinal stenosis. Methods April 2016 to October 2017, 45 patients with lumbar spinal stenosis (2 or 3 segments) were retro-spectively collected, including 21 males and 24 females. Age 50-74 years, average 62.5 ±11.2 years, which were divided into mini-invasive surgery group and open surgery group. In the mini-invasive group, 19 cases were treated with mini-invasive decompres-sion and intervertebral fusion internal fixation through Zista channel, including 14 cases with two segments and 5 cases with three segments. 26 cases were treated with traditional open surgery, 17 cases in two sections and 9 cases in three sections. The Japanese Orthopaedic Association score (JOA) and visual analogue scale (VAS) were used to assess the clinical effect postoperatively. The change of spinal canal in the mini-invasive group was assessed by lateral recess angle. Results All of the 45 operations had been completed successfully. The average operation time in mini-invasive surgery group was 240 ± 15 min (range, 230-310) for 2 seg-ments and 320 ± 15 min (range, 320-370) for 3 segments. The average operation time in open surgery group was 255 ± 15 min (range, 210-300) for 2 segments and 315±20 min (range, 330-390) for 3 segments, there was no significant difference between two groups. The intraoperative blood loss in mini-invasive surgery group was 220±25 ml (range, 190-310) for 2 segments and 340±30 ml (range, 280-410) for 3 segments. The intraoperative blood loss in open surgery group was 550 ± 25 ml (range, 500-730) for 2 segments and 840 ± 20 ml (range, 750-920) for 3 segments, the bleeding volume of the open surgery group was more than that of the mini-invasive group. All patients were followed up, and the follow-up time was 7.3±3.2 months (range, 3-12 months) in mini-invasive surgery group and 8.1 ± 2.6 months (range, 3-12 months) in open surgery group respectively. The VAS score of low backpain and lower limb pain in the two groups was decreased 4.2 and 5.4 in mini-invasive group, 4.7 and 5.1 in open surgery group at 3 months after operation. The average JOA score of the two groups increased 13.3 in mini-invasive group and 12.7 in open surgery group at 3 months after the operation. The latera recess angle in mini-invasive group between preoperation and postoperation was significantly different. No incisional infection, implant loosening, discitis and leakage of cerebrospinal fluid were found. Conclu-sion Mini-invasive decompression and internal fixation through Zista channel for lumbar spinal stenosis is a safe, effective and minimally invasive method of operation with the characteristics of short operation time, less intraoperative blood loss and low com-plications.
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