中国医药指南
中國醫藥指南
중국의약지남
CHINA MEDICINE GUIDE
2013年
19期
430-432
,共3页
微创%腰椎滑脱%腰椎弓根%多裂肌
微創%腰椎滑脫%腰椎弓根%多裂肌
미창%요추활탈%요추궁근%다렬기
Minimally invasive%Spondylolisthesis%Lumbar pedicle%Multifidus
目的观察取袋鼠体位，经腰长短肌肌间隙入路置钉，二支撑点着力提拉复位等（下称综合微创）措施对腰椎滑脱进行经后路椎弓根钉棒复位，椎间植骨融合的手术效果。方法自2006年1月至2011年1月，对58例需要手术治疗的I～III度的腰椎滑脱患者，采用综合微创手术。并进行为期12～29个月随访，平均15个月。观察手术时间，术中出血量，手术创伤，手术并发症，临床效果，滑脱角和椎间高度，滑脱复位率及融合率。结果手术时间90～130min，平均110min，出血量200～600mL，平均350mL。无硬脊膜撕裂。术后2例患肢皮肤麻木加重，3个月后恢复。2例患肢仍疼痛，2周后消失。切口全部I期愈合。术后1周内X线检查，54例滑脱完全复位，4例复位率＞90%。末次随访未见复位丢失，融合率98.2%。未发生断钉、断棒。无“融合病”发生。结论综合微创手术措施治疗I～III度腰椎滑脱，手术时间短，创伤小，出血少，减压彻底，并发症少，滑脱椎复位、融合率高，临床疗效优良。
目的觀察取袋鼠體位，經腰長短肌肌間隙入路置釘，二支撐點著力提拉複位等（下稱綜閤微創）措施對腰椎滑脫進行經後路椎弓根釘棒複位，椎間植骨融閤的手術效果。方法自2006年1月至2011年1月，對58例需要手術治療的I～III度的腰椎滑脫患者，採用綜閤微創手術。併進行為期12～29箇月隨訪，平均15箇月。觀察手術時間，術中齣血量，手術創傷，手術併髮癥，臨床效果，滑脫角和椎間高度，滑脫複位率及融閤率。結果手術時間90～130min，平均110min，齣血量200～600mL，平均350mL。無硬脊膜撕裂。術後2例患肢皮膚痳木加重，3箇月後恢複。2例患肢仍疼痛，2週後消失。切口全部I期愈閤。術後1週內X線檢查，54例滑脫完全複位，4例複位率＞90%。末次隨訪未見複位丟失，融閤率98.2%。未髮生斷釘、斷棒。無“融閤病”髮生。結論綜閤微創手術措施治療I～III度腰椎滑脫，手術時間短，創傷小，齣血少，減壓徹底，併髮癥少，滑脫椎複位、融閤率高，臨床療效優良。
목적관찰취대서체위，경요장단기기간극입로치정，이지탱점착력제랍복위등（하칭종합미창）조시대요추활탈진행경후로추궁근정봉복위，추간식골융합적수술효과。방법자2006년1월지2011년1월，대58례수요수술치료적I～III도적요추활탈환자，채용종합미창수술。병진행위기12～29개월수방，평균15개월。관찰수술시간，술중출혈량，수술창상，수술병발증，림상효과，활탈각화추간고도，활탈복위솔급융합솔。결과수술시간90～130min，평균110min，출혈량200～600mL，평균350mL。무경척막시렬。술후2례환지피부마목가중，3개월후회복。2례환지잉동통，2주후소실。절구전부I기유합。술후1주내X선검사，54례활탈완전복위，4례복위솔＞90%。말차수방미견복위주실，융합솔98.2%。미발생단정、단봉。무“융합병”발생。결론종합미창수술조시치료I～III도요추활탈，수술시간단，창상소，출혈소，감압철저，병발증소，활탈추복위、융합솔고，림상료효우량。
Objective To study the surgical effect of posterior transpedicular screw and rod reduction and lumbar interbody fusion via a series of procedures such as placing screws through the psoas major and psoas minor space, elevating, pulling and reduction on two supporting points and so on (called minimally invasive), on patients with spondylolisthesis operated in a kangaroo posture. Methods From January 2006 to January 2011, 58 patients with Grade I--III spondylolisthesis underwent minimally invasive surgery and the follow-up of the operated patients was between 12 and 29 months (an average of 15 months). The operative time, blood loss of operation, surgical wounds, complications, clinical effects, slip angle, intervertebral height, reduction rate and fusion rate were reviewed and evaluated, retrospectively. Results The mean operative time was 110 minutes (range 90 to 130) and the average blood loss was 350 mL (range 200 to 600). No dural tear was noted. 2 cases developed increasing skin numbness following surgery, which recovered three months later, while pain remained in 2 patients after operation, which resolved two weeks later. All surgical incisions achieved primary healing. X-rays, taken one week after surgery, showed that 54 cases demonstrated complete reduction and the reduction rate of 4 cases is greater than 90%. At final follow-up, neither loss of reduction nor screw or rod breakage was observed. The fusion rate reaches 98.2%. Besides, operatively induced worsen and intractable pain did not occur in any cases. Conclusion The minimally invasive approach is an efficient treatment of Grade I to III spondylolisthesis, with significant advantages of short operative time, less surgical wounds and complications, decreasing blood loss, thorough decompression, high reduction and fusion rate as well as excellent clinical outcome.
