中华骨科杂志
中華骨科雜誌
중화골과잡지
CHINESE JOURNAL OF ORTHOPAEDICS
2011年
10期
1099-1103
,共5页
顾广飞%贺石生%张海龙%顾昕%张立国%丁悦%贾建波%周旭%李佳怡%袁超群%袁嘉敏
顧廣飛%賀石生%張海龍%顧昕%張立國%丁悅%賈建波%週旭%李佳怡%袁超群%袁嘉敏
고엄비%하석생%장해룡%고흔%장입국%정열%가건파%주욱%리가이%원초군%원가민
外科手术,微创性%腰椎%椎管狭窄
外科手術,微創性%腰椎%椎管狹窄
외과수술,미창성%요추%추관협착
Surgical procedures,minimally invasive%Lumbar vertebrae%Spinal stenosis
目的 探讨退变性腰椎管狭窄症的微创治疗策略.方法 回顾性分析2008年3月至2010年8月采用微创手术治疗的73例腰椎管狭窄症患者,根据患者的临床、影像学表现及是否合并其它脊柱疾病进行分类,对不同类型病变采取不同的微创手术方式,分别统计手术时间、出血量、手术并发症及术前、术后6个月和末次随访时日本矫形外科学会(Japanese Orthopaedic Association,JOA)评分及Oswestry功能障碍指数(Oswestry disability index,ODI),根据JOA评价标准对手术疗效进行评价.结果 73例微创手术均顺利完成.25例患者采用双侧减压方法,48例患者采用单侧入路潜行双侧减压;23例患者在减压的同时进行椎间融合加经皮内固定手术.手术时间、术中出血量与减压方式及是否行椎间融合内固定相关.术中硬膜囊撕裂1例;1例骨质疏松患者行椎间融合时融合器打入上位椎体中,取出融合器,予椎体间植骨融合;术后出现切口愈合不良3例,考虑与术中微创可扩张通道撑开过紧有关,予抗炎及换药后切口愈合.术后随访10～35个月,平均13个月.患者术前及术后6个月的JOA评分和ODI明显改善,差异有统计学意义(P＜0.01).23例行椎间融合及内固定患者,22例患者获得满意融合,无螺钉断裂及松动发生.结论 微创手术治疗腰椎管狭窄症疗效肯定,但应根据腰椎管狭窄症患者的临床、影像学表现、合并疾患及术者的临床经验和医院的具体条件来选择合适的手术方式.
目的 探討退變性腰椎管狹窄癥的微創治療策略.方法 迴顧性分析2008年3月至2010年8月採用微創手術治療的73例腰椎管狹窄癥患者,根據患者的臨床、影像學錶現及是否閤併其它脊柱疾病進行分類,對不同類型病變採取不同的微創手術方式,分彆統計手術時間、齣血量、手術併髮癥及術前、術後6箇月和末次隨訪時日本矯形外科學會(Japanese Orthopaedic Association,JOA)評分及Oswestry功能障礙指數(Oswestry disability index,ODI),根據JOA評價標準對手術療效進行評價.結果 73例微創手術均順利完成.25例患者採用雙側減壓方法,48例患者採用單側入路潛行雙側減壓;23例患者在減壓的同時進行椎間融閤加經皮內固定手術.手術時間、術中齣血量與減壓方式及是否行椎間融閤內固定相關.術中硬膜囊撕裂1例;1例骨質疏鬆患者行椎間融閤時融閤器打入上位椎體中,取齣融閤器,予椎體間植骨融閤;術後齣現切口愈閤不良3例,攷慮與術中微創可擴張通道撐開過緊有關,予抗炎及換藥後切口愈閤.術後隨訪10～35箇月,平均13箇月.患者術前及術後6箇月的JOA評分和ODI明顯改善,差異有統計學意義(P＜0.01).23例行椎間融閤及內固定患者,22例患者穫得滿意融閤,無螺釘斷裂及鬆動髮生.結論 微創手術治療腰椎管狹窄癥療效肯定,但應根據腰椎管狹窄癥患者的臨床、影像學錶現、閤併疾患及術者的臨床經驗和醫院的具體條件來選擇閤適的手術方式.
목적 탐토퇴변성요추관협착증적미창치료책략.방법 회고성분석2008년3월지2010년8월채용미창수술치료적73례요추관협착증환자,근거환자적림상、영상학표현급시부합병기타척주질병진행분류,대불동류형병변채취불동적미창수술방식,분별통계수술시간、출혈량、수술병발증급술전、술후6개월화말차수방시일본교형외과학회(Japanese Orthopaedic Association,JOA)평분급Oswestry공능장애지수(Oswestry disability index,ODI),근거JOA평개표준대수술료효진행평개.결과 73례미창수술균순리완성.25례환자채용쌍측감압방법,48례환자채용단측입로잠행쌍측감압;23례환자재감압적동시진행추간융합가경피내고정수술.수술시간、술중출혈량여감압방식급시부행추간융합내고정상관.술중경막낭시렬1례;1례골질소송환자행추간융합시융합기타입상위추체중,취출융합기,여추체간식골융합;술후출현절구유합불량3례,고필여술중미창가확장통도탱개과긴유관,여항염급환약후절구유합.술후수방10～35개월,평균13개월.환자술전급술후6개월적JOA평분화ODI명현개선,차이유통계학의의(P＜0.01).23례행추간융합급내고정환자,22례환자획득만의융합,무라정단렬급송동발생.결론 미창수술치료요추관협착증료효긍정,단응근거요추관협착증환자적림상、영상학표현、합병질환급술자적림상경험화의원적구체조건래선택합괄적수술방식.
Objective To explore the ideal minimally invasive surgical method for degenerative lumbar spine stenosis.Methods From March 2008 to August 2010,73 cases with lumbar spinal stenosis underwent minimal invasive surgery were retrospectively analyzed.The patients were divided into different groups by clinical features,imaging manifestations,and concurrent diseases.The minimal invasive surgical methods were chosen according to the classification.Operation time,intra-operative bleeding,and complications were recorded.The lumbar function was evaluated by Oswestry disability index (ODI),and the clinical results were assessed by JOA pre- and postoperatively.Results Minimal invasive surgery was completed in all cases,which included 25 cases with bilateral decompression and 48 cases with unilateral approach for bilateral decompression.Twenty-three cases used interbody fusion and percutaneous pedicle screw fixation after decompression.Intraoperative blood loss and operation time were related to surgical methods.One case was complicated with dural tear.Cage was inserted into upper vertebral body during interbody fusion in 1case with osteoporosis,removed the cage and implanted bone fusion.Incisions of 3 cases were poor healing after surgery.The average follow up time was 13 months (range,10-35).JOA score and ODI before surgery were 9.2±5.1 and 62.3％±18.5％ respectively; while 6 months after surgery,JOA score and ODI were 23.5±7.2 and 18.4％±6.4％ respectively.JOA score and ODI showed statistically significant improvements after operation (P＜0.01).Twenty-two cases got solid fusion at the final follow-up.Conclusion Treatment of lumbar spinal stenosis by minimal invasive surgery has satisfactory surgical outcomes,but the proper minimal invasive strategy should be chosen according to specific patients,surgeons and hospitals.
