颈椎间孔椎体间融合术在腰椎间盘突出症中的应用.doc

通道辅助下经关节突减压结合Dynesys固定治疗腰椎退行性疾病的临床疗效 谢虎，陈新，崔江潮，安全明 宜昌市第二人民医院脊柱外科，湖北 宜昌 443000 摘要 目的 探讨通道辅助下经关节突减压结合Dynesys固定治疗腰椎退行性疾病的临床疗效。方法 2011年9月至2013年9月应用通道辅助下经关节突减压结合Dynesys固定治疗腰椎退行性疾病患者36例，男20例，女16例；年龄31～67岁，平均44.6岁。其中腰椎管狭窄症14例，腰椎间盘突出症22例。一个节段28例，两个节段8例。手术方法首先采用肌间隙入路可扩张通道辅助下置入Dynesys螺钉，凿除部分关节突关节，切除增厚的黄韧带，暴露椎间孔，切除椎体后缘骨赘及突出的椎间盘，使中央椎管及神经根管管径扩大。减压满意后按照常规方法完成Dynesys。术前、术后及末次随访采用VAS、ODI进行评分，根据X线片评价腰椎活动度情况。 结果 本组病例术中无并发症，随访9～33个月，平均20个月。术前VAS评分7.41±1.19(6-10)，术后评分2.44±1.46(0-5)，末次随访评分2.25±1.50(0-5)，末次随访、术后与术前VAS评分有统计学意义（P=0.000）；术前ODI评分66.24±16.59（46-90），术后ODI评分23.59±12.23（0-42），末次随访ODI评分20.44±10.27（0-52），末次随访、术后与术前ODI评分有统计学意义（P=0.000）。随访X线动力位示所有病例均无腰椎不稳征象，Dynesys系统无松动、断裂、变形。结论 通道辅助下经关节突减压结合Dynesys固定，可有效减少手术创伤，保留腰椎extendable retractor in the treatment of lumbar degenerative diseases XIE Hu, CHEN Xin, CUI Jiangchao, AN Quanming Department of spinal surgery, Second People’s Hospital of Yichang, Yichang 443000 Abstract Objective To investigate the clinical effects of Dynesys system in addition to transfacet decompression via extendable retractor in the treatment of lumbar degenerative diseases. Methods From September 2011 to September 2013, 36 patients suffering from lumbar degenerative disease were treated. There were 20 males and 16 females with average age of 44.6. The preoperative diagnosis included lumbar spinal stenosis(14 cases); lumber intervertebral disc herniation (22 cases)．There were 28 cases in single level and 8 cases in double levels. Posterolateral fixation with Dynesys pedicle screws via extendable retractor and then resect part of the facet joint and lamina to expose unilaterally the intervertebral vertebral foramen. Decompression of the vertebral canal wag by removing the disc until the nerve root was decompressed satisfactorily．In the end, Dynesys was performed according to normal procedure. VAS, ODI evaluating standards were applied to evaluate the therapeutic effect. The ROM of the lumbar were observed by X-ray scan. Results All patients underwent surgery s