| X-Tube辅助下单侧神经根减压椎间植骨融合内固定术的临床应用 |
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Received:February 03, 2010
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| 作者 | Author | 单位 | Unit | E-Mail |
| 王健 |
WANG Jian |
浙江省立同德医院骨科,浙江 杭州 310012 |
Department of Orthopaedics,the Tongde Hospital of Zhejiang Province,Hangzhou 310012,Zhejiang,China |
hztdwangjian@163.com |
| 张春 |
ZHANG Chun |
浙江省立同德医院骨科,浙江 杭州 310012 |
Department of Orthopaedics,the Tongde Hospital of Zhejiang Province,Hangzhou 310012,Zhejiang,China |
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| 期刊信息：《中国骨伤》2010年23卷，第5期，第360-363页 |
| DOI：10.3969/j.issn.1003-0034.2010.05.014 |
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目的：探讨扩张通道管系统(METRx X-Tube)辅助下单侧神经根减压腰椎椎间融合术治疗腰椎间盘退行性疾病的可行性及临床疗效。
方法：自2005年5月至2009年6月应用X-Tube辅助行微创单侧经后路腰椎体间融合(PLIF)术治疗退行性腰椎间盘疾病患者29例，男12例，女17例；年龄27～68岁，平均52.4岁；椎间盘源性腰痛11例，单侧椎间盘突出伴椎间隙狭窄15例，腰椎间盘突出症术后复发3例。其中L4,5病变18例，L5S1病变11例。
结果：29例手术时间平均145 min;术中出血平均350 ml.29例均获随访，时间5～19个月，平均9.8个月。VAS疼痛评分由术前(7.3±6.7)分降至术后1个月(2.3±0.8)分，末次随访(1.3±0.5)分；ODI功能障碍评分由术前(44.8±7.1)分降至术后1个月(16.3±5.7)分，末次随访(2.6±4.5)分；手术疗效按照改良Macnab标准评价，优19例、良7例、可3例。在随访时间超过9个月的25例患者中，有23例经X线及螺旋CT扫描结合二维重建显示椎间隙已经明显骨性融合，手术疗效良好。
结论：X-Tube辅助下单侧神经根减压椎间植骨融合内固定术治疗腰椎间盘退行性疾病具有术中出血量少、创伤小、术后恢复快、近期疗效确切等优点。是临床上可行、实用的一种微创术式，适用于L2,3至L5S1节段病变的治疗，但由于X-Tube工作通道能提供的操作空间有限，手术视野小，所以术中的操作顺序以及术前的病例选择尤其重要。 |
| [关键词]:外科手术,微创性 脊柱融合术 腰椎 椎间盘 |
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| Preliminary evaluation and clinical application of unilateral decompression,interbody fusion and pedicle screw fixation under endoscopic system |
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Abstract:
Objective: To explore the feasibility and efficiency of treatment of lumbar degenerative disease with unilateral decompression,interbody fusion and percutaneous pedicle screw fixation assisted by X-Tube systerm for the management of degenerative lumbar disease.
Methods: A total of 29 patients with degenerative lumbar,disease including 12 males and 17 females with an average age of 52.4 years ranging from 27 to 68 years,underwent minimally invasive posterior lumbar interbody fusion(PLIF) or TLIF assisted by the X-Tube system. The index diagnosis was discogenic low back pain in 11 cases,intervertebral space stenosis with unilateral herniated nucleus pulposus in 15 cases,recurrecce after operation of lumbar intervertebral disc herniation in 3 cases. The diseased segment was in L4,5 in 18 cases,L5S1 in 11.
Results: The operative duration were 138 to 190 min (means 145 min); the blood loss was 230 to 560 ml (means 350 ml). Total 29 patients were followed-up from 5 to 19 months (means 9.8 months). The changes the clinical functional outcomes were evaluated according to the VAS pain score and the Oswestry Disability Index questionnaire. The VAS pain score decreased from(7.3±6.7) preoperatively to(2.3±0.8) at postoperative one month and(1.3±0.5) at final follow-up; The average ODI scores decreased from (44.8±7.1) preoperatively to (16.3±5.7) at postoperative one month and (2.6±4.5) at final follow-up. According to the Macnab criteria,the clinical effects were excellent in 19 cases,good in 7 cases and fair in 3 cases. Twenty-five patients were followed-up more than 9 months,23 cases of them had showed remarkale bony interbody fusion on the X-rays and CT. The outeomes of operation was satisfied.
Conclusion: Minimally invasive PLIF assisted by X-Tube system minimize blood loss and tissue tuauma,shorten the operative,recovery and bony union time,the short-term outeomes are excellent which make it a valuable alternative to conventional surgical peocedures and suitable to segments from L2 to S1. The shortcomings are confined operating space and field of X-Tube system. |
| KEYWORDS:Surgical procedures,minimally invasive Spinal fusion Lumbar vertebrae Intervertebral disk |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 王健,张春.X-Tube辅助下单侧神经根减压椎间植骨融合内固定术的临床应用[J].中国骨伤,2010,23(5):360~363 |
| 英文格式: | WANG Jian,ZHANG Chun.Preliminary evaluation and clinical application of unilateral decompression,interbody fusion and pedicle screw fixation under endoscopic system[J].zhongguo gu shang / China J Orthop Trauma ,2010,23(5):360~363 |
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