经椎旁肌入路MIS-PLIF联合经皮置入长臂椎弓根螺钉固定治疗中央型腰椎间盘突出和中央型椎管狭窄症

摘要

目的：探讨经椎旁肌入路MIS- PLIF（ Minimally invasive—Posterior lumbar interbody fusion，MIS—PLIF)联合经皮置入长臂椎弓根螺钉固定治疗中央型腰椎间盘突出和中央型椎管狭窄症的临床疗效。方法：2012年4月一2014年4月，采用多裂肌肌束或椎旁肌间隙入路的MIS- PLIF联合经皮长臂椎弓根螺钉固定治疗中央型腰椎间盘突出症和中央型腰椎管狭窄49例并进行随访，统计指标包括：手术时间手术出血量、术后住院时间术后并发症；术后1周3月6月12月及末次随访的患者的腰腿痛VAS评分、JOA评分以及末次随访融合情况。结果：本组所有病例都得到5～18个月随访。平均11个月，平均手术时间117±20min，平均出血量为113±39 ml。术后平均住院时间7天，术后1周3月6月12月及末次随访时腿痛VAS评分及腰腿痛JOA评分与术前相比有差异，有统计学意义(P<0.05)。末次随访91%患者达到了影像愈合标准。未发现融合器松动钉棒松动断裂等。结论：经椎旁肌入路MIS- PLIF联合经皮置入长臂椎弓根螺钉固定治疗中央型腰椎间盘突出和中央型椎管狭窄症患者具有术中暴露充分、创伤小、手术出血少、神经并发症少、术后疼痛轻等优点。%Objectives Objective To study the effectiveness of Minimal y invasive- Posterior lumbar interbody fusion (MIS- PLIF) with percutaneous long- arm pedicle screw fixation for the treatment of central- type lumbar disc herniation and stenosis. Methods From April 2012 to April 2014, we retrospectively analyzed 49 cases, who underwent MIS- PLIF combined with percuta-neous long- arm pedicle screw fixation for central- type lumbar disc herniation and spinal stenosis. Statistical parameters included:opera-tion time, blood loss, postoperative hospital stay, complications;VAS and JOA scores 1 week, 3 months, 12 months postoperatively, as well as fusion rate at the last follow- up. Results Postoperative follow- up ranged 5 ~18 months, on average 11 months. The average operation time was 117 ± 20 min, average blood loss was 113 ± 39 ml. Average postoperative hospital stay was 7 days. The postoper-ative VAS and JOA scores were statistically different from those before surgery (P<0.05). 91%of patients had solid fusion at the last fol-low- up. No screw loosening and rod breakage was noted. Conclusion:MIS- PLIF with percutaneous long- arm pedicle screw fixation for the treatment of central- type lumbar disc herniation and spinal stenosis had the advantages of intraoperative exposed fully, minimal trauma, less bleeding, fewer complications, and reduced postoperative pain.