经多裂肌与最长肌肌间隙入路行腰椎固定融合术治疗腰椎椎管狭窄症

摘要

Objective To explore the clinical curative effect of lumbar interbody fusion via intrasacrospinal muscular approach and midline approach for lumbar spinal stenosis. Methods Sixty-nine patients with lumbar spinal stenosis treated in our hospital from January 2011 to January 2015 were enrolled in the study, which were divided into two groups according the operation approach: group A of 39 cases treated via intrasacrospinal muscular approach and group B of 30 cases via midline approach. Operation time, the amount of blood loss, post-operative drainage, and the VAS score of low back pain and leg pain preoperatively at 6 months after operation were recorded. All patients were followed up for more than one year to evaluate fusion status. Results All patients were followed up for 12~18 months, with an average of (13±0.5) months, and all patients had bony fusion. There were significant difference in oper-ation time, blood loss and post-operative drainage between group A and group B [(90.5 ± 8.2) min vs (127.1 ± 9.8) min, (90.5 ± 8.2) mL vs (187.9 ± 10.5 ) mL, (45.8 ± 4.6) mL vs (85.1 ± 15.0) mL, P<0.05]. There was a significant difference in VAS of back pain and leg pain between group A and group B at 6 months after operation [(1.15 ± 0.52) vs (2.88 ± 0.61), (1.02±1.03) vs (2.69±0.79), P<0.05]. Conclusion Lumbar interbody fusion via intrasacrospinal muscular approach for lumbar spinal stenosis is better than midline approach in less injury to paraspinal muscle, less blood loss and less post-op-erative drainage, which contributes to a rapid recovery in the relieving the back pain and leg pain.%目的：探讨经多裂肌与最长肌肌间隙入路行腰椎固定融合术治疗腰椎椎管狭窄症的临床疗效。方法回顾性分析2011年1月至2015年1月收治的腰椎椎管狭窄症69例，按照手术入路的不同分成两组，A组39例经多裂肌与最长肌肌间隙入路手术，B组30例经后正中入路手术，比较两组患者的手术时间、术中出血量、术后引流量；评价术前和术后6个月两组患者的腰腿痛视觉模拟评分(VAS评分)及术后12个月的椎间植骨融合情况。结果69例患者均获得随访，随访时间12~18个月，平均(13±0.5)个月，末次随访时均获得骨性融合。A组患者的手术时间、术中出血量和术后引流量分别为(90.5±8.2) min、(90.5±8.2) mL和(45.8±4.6) mL，B组分别为(127.1±9.8) min、(187.9±10.5) mL和(85.1±15.0) mL ，两组比较差异均有统计学意义(P<0.05)。A组患者术后6个月的腰、腿痛VAS评分分别为(1.15±0.52)分、(1.02±1.03)分，其缓解程度优于B组的(2.88±0.61)分、(2.69±0.79)分，差异均有统计学意义(P<0.05)。结论经多裂肌与最长肌肌间隙入路行腰椎固定融合术治疗腰椎椎管狭窄症具有对椎旁肌损伤较小、手术时间略短、术中及术后出血较少、术后中短期腰腿痛缓解程度较佳的优势。