微切口经皮椎弓根螺钉技术在腰椎微创融合手术中的应用

摘要

目的：探讨微切口经皮椎弓根螺钉技术在腰椎微创融合手术中的应用效果。方法回顾性研究2011年2月至2014年1月采用微切口经皮椎弓根螺钉技术治疗的腰椎管狭窄症和腰椎滑脱症共122例。其中男77例，女45例；年龄45~70岁，平均57.8岁。采用Quadrant微创通道下减压、椎间融合、微切口经皮椎弓根螺钉内固定和/或对侧经皮椎弓根螺钉内固定的手术方式，统计手术切口长度、手术时间、术中出血量、术后椎间融合情况，记录手术前后的疼痛视觉模拟量表（visual analogue scale, VAS）评分、Oswestry功能障碍指数（Oswestry disability index, ODI），按Suk标准评估植骨融合情况和Nakai分级进行疗效评估。结果122例患者均完成手术。其中112例患者获得随访，随访时间为12~33个月，平均16.5个月。术后1、6、12个月VAS评分和ODI均较术前下降，差异均有统计学意义（均P＜0.05）。按Suk标准评估：107例椎间骨性融合（95.54%），3例可能融合（2.68%），2例未融合（1.79%）。根据Nakai分级：优83例（74.11%），良20例（17.86%），可6例（5.36%），差3例（2.68%），优良率为91.96%。结论微创通道下减压椎间融合结合微切口经皮椎弓根螺钉技术治疗腰椎退行性疾病。%Objective To evaluate the effect of surgical treatment of lumbar canal decompression, in⁃terbody fusion through the Quadrant channel combined with microincision percutaneous pedicle screw fixation in patients with lumbar degenerative disease. Methods 122 patients, including 77 males and 45 females, were treated in our department between February 2011 and January 2014. Their mean age was 57.8 years (range 45⁃70 years). Lumbar canal decompression, interbody fusion through the Quadrant channel combined with microin⁃cision percutaneous pedicle screw fixation was applied in all patients. Results 112 patients were followed up for 12⁃33 months (average, 16.5 months). 107 cases got bony fusion (95.54%), poor bony fusion occurred in 3cases (2.68%) and no bony fusion in 2 cases (1.79%). Postoperative VAS scores and ODI were decreased sig⁃nificantly as compared with those pre⁃operation (P<0.05). According to the Nakai criteria, the clinical effect was excellent in 83 cases (74.11%), good in 20 cases (17.86%), fair in 6 cases (5.36%) and bad in 3 cases (2.68%). Conclusion Our minimally invasive surgery was available for clinical choice in treatment of lumbar degenerative disease, which can obtain a satisfactory clinical effect.