中华骨科杂志
中華骨科雜誌
중화골과잡지
CHINESE JOURNAL OF ORTHOPAEDICS
2011年
10期
1116-1121
,共6页
张春霖%朱红鹤%李莹%严旭%王铮%陈博光
張春霖%硃紅鶴%李瑩%嚴旭%王錚%陳博光
장춘림%주홍학%리형%엄욱%왕쟁%진박광
腹腔镜%脊椎前移%治疗结果
腹腔鏡%脊椎前移%治療結果
복강경%척추전이%치료결과
Laparoscopes%Spondylolisthesis%Treatment outcome
目的 评价腹腔镜辅助下经前后路手术治疗重度(Ⅲ、Ⅳ度)腰椎滑脱症的手术操作方法及临床疗效.方法 2007年12月至2010年5月,采用后路椎间盘镜行双侧神经二次减压、经皮椎弓根钉复位及前路腹腔镜下椎间植骨钛板内固定融合治疗Ⅲ、Ⅳ度腰椎滑脱症患者13例,男6例,女7例;年龄18～58岁,平均39.8岁.Ⅲ度滑脱患者11例,Ⅳ度滑脱患者2例.滑脱部位:L4,52例,L5S1 11例.根据滑脱率、滑脱角、椎间隙后高度改变及临床Oswestry功能障碍指数评估疗效.结果 术后随访12至36个月,平均21个月.手术时间105～150 min,平均125 min;出血量200～900ml,平均415 ml.滑脱率减小56.9％(术前73.3％±6.1％,术后16.4％±9.5％);滑脱角减小19.6°(术前27.7°±5.6°,术后8.1°±8.8°);椎间隙后高度增大7.1 mm[术前(2.6±0.8)mm,术后(9.7±3.7)mm].临床Oswestry功能障碍指数下降19.5分[术前(35.8±5.7)分,术后(16.3±5.2)分].CT扫描术后1年椎体间均骨性融合.术中发生硬膜囊撕裂1例,切口浅表感染1例.疗效优4例,良8例,可1例.结论 腔镜辅助下经前后路手术治疗Ⅲ、Ⅳ度腰椎滑脱症可实现彻底减压及尽可能的解剖复位,前后内固定协同稳定性好,椎间植骨融合可靠,手术创伤小,临床疗效满意.
目的 評價腹腔鏡輔助下經前後路手術治療重度(Ⅲ、Ⅳ度)腰椎滑脫癥的手術操作方法及臨床療效.方法 2007年12月至2010年5月,採用後路椎間盤鏡行雙側神經二次減壓、經皮椎弓根釘複位及前路腹腔鏡下椎間植骨鈦闆內固定融閤治療Ⅲ、Ⅳ度腰椎滑脫癥患者13例,男6例,女7例;年齡18～58歲,平均39.8歲.Ⅲ度滑脫患者11例,Ⅳ度滑脫患者2例.滑脫部位:L4,52例,L5S1 11例.根據滑脫率、滑脫角、椎間隙後高度改變及臨床Oswestry功能障礙指數評估療效.結果 術後隨訪12至36箇月,平均21箇月.手術時間105～150 min,平均125 min;齣血量200～900ml,平均415 ml.滑脫率減小56.9％(術前73.3％±6.1％,術後16.4％±9.5％);滑脫角減小19.6°(術前27.7°±5.6°,術後8.1°±8.8°);椎間隙後高度增大7.1 mm[術前(2.6±0.8)mm,術後(9.7±3.7)mm].臨床Oswestry功能障礙指數下降19.5分[術前(35.8±5.7)分,術後(16.3±5.2)分].CT掃描術後1年椎體間均骨性融閤.術中髮生硬膜囊撕裂1例,切口淺錶感染1例.療效優4例,良8例,可1例.結論 腔鏡輔助下經前後路手術治療Ⅲ、Ⅳ度腰椎滑脫癥可實現徹底減壓及儘可能的解剖複位,前後內固定協同穩定性好,椎間植骨融閤可靠,手術創傷小,臨床療效滿意.
목적 평개복강경보조하경전후로수술치료중도(Ⅲ、Ⅳ도)요추활탈증적수술조작방법급림상료효.방법 2007년12월지2010년5월,채용후로추간반경행쌍측신경이차감압、경피추궁근정복위급전로복강경하추간식골태판내고정융합치료Ⅲ、Ⅳ도요추활탈증환자13례,남6례,녀7례;년령18～58세,평균39.8세.Ⅲ도활탈환자11례,Ⅳ도활탈환자2례.활탈부위:L4,52례,L5S1 11례.근거활탈솔、활탈각、추간극후고도개변급림상Oswestry공능장애지수평고료효.결과 술후수방12지36개월,평균21개월.수술시간105～150 min,평균125 min;출혈량200～900ml,평균415 ml.활탈솔감소56.9％(술전73.3％±6.1％,술후16.4％±9.5％);활탈각감소19.6°(술전27.7°±5.6°,술후8.1°±8.8°);추간극후고도증대7.1 mm[술전(2.6±0.8)mm,술후(9.7±3.7)mm].림상Oswestry공능장애지수하강19.5분[술전(35.8±5.7)분,술후(16.3±5.2)분].CT소묘술후1년추체간균골성융합.술중발생경막낭시렬1례,절구천표감염1례.료효우4례,량8례,가1례.결론 강경보조하경전후로수술치료Ⅲ、Ⅳ도요추활탈증가실현철저감압급진가능적해부복위,전후내고정협동은정성호,추간식골융합가고,수술창상소,림상료효만의.
Objective To evaluate the clinical outcome of endoscope-assisted combined anterior and posterior procedures for grade-Ⅲ and Ⅳspondylolisthesis.Methods From December 2007 to May 2010,13 patients with grade-Ⅲ and Ⅳ spondylolisthesis were treated with two bilateral decompression,percutaneous pedicle screw restoration,intervertebral bone grafting and plate fixation using microendoscopic discectomy and laparoscopy,including 6 males and 7 females with an average age of 39.8 years (range,18-58 years).Eleven cases were in grade Ⅲ spondylolisthesis and two in Ⅳ.The lesion location was as follows:2 cases were at L4,5 and 11 at L5S1.The clinical outcomes were evaluated according to Oswestry disability questionnaire,and the change of radiographic data including slipping degree,slipping angle and posterior height of intervertebral disc.Results The mean follow-up time was 21 months (range,12-36 months).The mean operative time was 125 min,with a mean blood loss of 415 ml.Slipping degree decreased 56.9％ in average (from preoperative 73.3％±6.1％ to postoperative 16.4％±9.5％),slipping angle decreased 19.6°(from preoperative 27.7°±5.6° to postoperative 8.1°±8.8°),posterior height of intervertebral disc increased 7.1 mm (from preoperative 2.6 ±0.8 mm to postoperative 9.7 ±3.7 mm).The clinical outcomes of the Oswestry disability questionnaire decreased 19.5 (from preoperative 35.8±5.7 to postoperative 16.3±5.2).CT scans demonstrated that solid bony fusion could be obtained in one year after operation.Complications included dural sac tears in 1 case,and superficial incision infection in 1.The results were excellent in 4 cases,good in 8 and fair in 1.Conclusion Endoscope-assisted anterior and posterior procedures for grade-Ⅲ and Ⅳ spondylolisthesis is a reliable method,which can lead to rigid fixation and fusion,and also can achieve thorough decompression and restoration as much as possible.
