Vista系统联合Sextant-R系统微创治疗单间隙腰椎退行性滑脱症

摘要

Objective To evaluate the clinical efficacy of the minimally invasive treatment with Vista system combined with Sextant-R system for single-level degenerative lumbar spondylolisthesis. Methods This study retrospectively reviewed 25 consecutive patients with single-level lumbar degenerative disease between July 2015 and May 2016, who were managed with surgery. Patients included 10 men and 15 women, aged 61.0±5.5 years (range 48-79 years). L4/5 spondylolisthesis occurred in 12 patients, while L5/S1 spondylolisthesis occurred in 13 patients. According to Meyerding radiographic grading system, 23 patients were of typeⅠand 2 of typeⅡ. Preoperation, three days postoperation (at discharge) and at last follow-up, lumbar functionscores on a visual analog scale (VAS) and Japanese Orthopaedic Association (JOA) were collected and the rate of JOA improvement was also calculated. The bony fusion rate was evaluated by the Suk standard. Results The duration of follow-up with 25 patients was 6-13 months (mean 9.5±2.5 months). The VAS score was 7.13±0.73 before operation, 1.58 ± 0.51 at 3rd day postoperation and 1.21 ± 0.31 the VAS score at the last follow-up. Preoperative JOA score was 9.55 ± 0.71. The JOA score was 19.32 ± 2.21 at 3rd day after operation and 27.57 ± 2.38 at the final follow-up was. There was statistically significant difference (P<0.05) in VAS and JOA scores between 3rd day after operation and at the last follow-up with those preoperation. Cerebrospinal fluid leakage occurred in one case due to the ossification and adhesion of ossification tissue with epidural. The patient was cured by continuous drainage, direct pressure and other wound treatment after surgery. Wounds of all patients had primary healing and nerve roots or spinal cords were not injured. The reduction was achieved to some extent. All patients had good bone graft fusion and internal fixation was in good position. Conclusion The minimally invasive treatment with Vista system combined with Sextant-R system for single-level degenerative lumbar spondylolisthesis improves clinical outcomes.%目的 探讨Vista系统联合Sextant-R系统微创治疗单间隙腰椎退行性滑脱的临床疗效.方法 回顾性分析2015年7月至2016年5月间接受Vista系统联合Sextant-R系统微创治疗的单间隙腰椎退变型疾病25例的临床资料.其中,男10例,女15例;年龄为48~79岁,平均(61.0±5.5)岁.L4/5滑脱12例,L5/S1滑脱13例.根据Meyerding分级:Ⅰ度滑脱23例,Ⅱ度滑脱2例.采用疼痛视觉模拟量表(visual analogue scale,VAS)及日本骨科协会(Japanese Orthopaedic Association,JOA)腰椎功能评分对病人术前、术后3 d(出院时)、末次随访的腰椎功能进行评估,并计算JOA改善率,采用Suk标准评价植骨融合率.结果 25例病人均获得随访,随访时间为6~13个月,平均(9.5±2.5)个月.术前VAS评分为(7.13±0.73)分,术后3 d为(1.58±0.51)分,末次随访为(1.21±0.31)分;术前JOA评分为(9.55±0.71)分,出院3 d为(19.32±2.21)分,末次随访为(27.57±2.38)分,术后3 d、末次随访时的VAS、JOA评分与术前比较,差异均有统计学意义(均P<0.05).1例病人由于伴有骨化,骨化组织与硬脊膜粘连,出现脑脊液漏,术后经过持续引流、伤口加压等处理.所有病人伤口均一期愈合,均无神经根或脊髓损伤情况.滑脱均得到一定程度复位,植骨均骨性融合,内固定位置良好.结论 Vista系统联合Sextant-R系统微创治疗单间隙腰椎退变型滑脱临床效果确切,切实可行.