微创通道下减压融合联合经皮椎弓根螺钉固定术治疗腰椎退变性疾病

摘要

目的：探讨微创通道下经椎间孔减压联合椎体间融合辅助经皮椎弓根螺钉治疗腰椎退变性疾病的疗效。方法腰椎退变性疾病患者52例，行微创通道下经椎间孔减压联合椎体间融合辅助经皮椎弓根螺钉固定术治疗，观察手术时间、术中出血量、视觉模拟评分法（VAS）和Oswestry功能障碍指数（ODI）评分、并发症、椎间融合情况及疗效。结果52例患者均获得随访，平均随访14个月。手术时间为120～240 min，平均180．1 min；术中出血量100～350 ml，平均110．5 ml；发生并发症4例（7．7％）。末次随访时植骨融合48例（92．3％），可能融合3例（5．8％），未融合1例（1．9％）。 VAS评分及ODI评分均随时间延长而降低（P＜0．05）。末次随访时采用改良Macnab标准评价疗效，优37例（71．2％），良14例（26．9％），可1例（1．9％），优良率为98．1％（51/52）。结论微创通道下减压融合联合经皮椎弓根螺钉内固定治疗腰椎退变性疾病可获得较好疗效。%Objective To explore the efficacy of minimally invasive decompression and transforaminal lumbar interbody fusion ( TLIF ) combined with percutaneous pedicle screw fixation for the treatment of lumbar degenerative diseases.Methods Fifty-two patients with lumbar degenerative diseases were treated with minimally invasive decompression and TLIF combined with percutaneous pedicle screw fixation.The operation time,intraoperative blood loss,the scores of visual analogue scale(VAS) and Oswestry disability index(ODI),complications,intervertebral fusion and efficacy were observed . Results Fifty-two cases were all followed up and the mean time was 14 months.The operation time ranged from 120 to 240 minutes,the average was 180.1 minutes.The intraoperative blood loss ranged from 100 to 350 ml,the mean was 110.5 ml. There were 4 cases(7.7%) who had complications.In the final follow-up,48 cases(92.3%) achieved bony fusion,3 cases (5.8%) achieved possible bony fusion and one case (1.9%) did not achieve bony fusion.The scores of VAS and ODI decreased with the increasing time(P<0.05).The clinical outcomes were determined by using a modified Macnab criteria in the final follow-up, which revealed that 37 cases(71.2%) had excellent results,14(26.9%) good results and 1(1.9%) fair results.The excellent and good rate was 98.1%(51/52).Conclusion Minimally invasive decompression and TLIF combined with percutaneous pedicle screw fixation can provide good efficacy in treating lumbar degenerative diseases .