摘要
目的探讨椎间盘镜下减压、B-Twin融合器植骨融合术治疗腰椎间盘突出症伴腰椎不稳的临床疗效。方法2006年3月至2010年5月，收治腰椎间盘突出症伴腰椎不稳患者87例，男49例，女38例；年龄37-65岁，平均47．6岁。均为单节段病变，L3.43例、L4．543例、L5S1 41例。采用单枚B—Twin椎间融合51例（单枚组），双枚融合36例（双枚组）。采用Oswestry功能障碍指数（Oswestry disability index，ODI）、疼痛视觉模拟评分（visual analogue scale，VAS）评估患者术后疗效，并比较两组患者手术时间、出血量、融合时间和椎间隙高度的变化。结果均获得12-46个月的随访，平均35．8个月。术后腰腿痛症状均明显缓解或消失。ODI术前平均为78％±3％，末次随访平均为18％±3％；VAS评分术前平均为（8．70±1．3）分，末次随访平均为（0．65±0．48）分；椎间隙高度术前平均为（8．76±1．3）mm，术后1个月平均为（12．8±1．5）mm，术后12个月平均为（11．8±0．6）mm。单枚组与双枚组ODI、VAS和椎间隙高度的差异均无统计学意义，但在手术时间、术中出血量方面的差异均有统计学意义，单枚组少于双枚组。均获融合或可能融合，融合时间3．9-8．6个月，平均为5．6个月。结论椎间盘镜下减压、B-Twin融合器植骨融合术治疗腰椎间盘突出症伴腰椎不稳的疗效满意，单枚与双枚融合疗效相近，单枚融合具有手术时间短、出血量少、医疗费用低的优点。
Objective To explore the clinical outcomes of posterior lumbar interbody fusion using B- Twin expandable spinal spacer with mieroendoscopic discectomy （MED） for lumbar disc herniation accompanying degenerative instability. Methods From March 2006 to May 2010, 87 patients with lumbar disc heniation （only one level） accompanying degenerative instability were managed with posterior lumbar interbedy fusion using B-Twin with MED, indudeing 49 males and 38 females with an average of 47.6 years （range, 37-65）. Objective level located in L3.4 in 2 cases, L4.5 in 43, and L5S1 in 41. The patients were treated with single B- Twin （Single group, n=51） and double B-Twin （Double group, n=36）. Clinical outcomes were evaluated with surgical time, blood loss, visual analogue scale （VAS） scores, Oswestry disability questionnaire （ODI）, and the pre- and post-operative disk space heights. Results The patients were followed up for an average of 35.8 months （range, 12-46）. All the patients felt the low back pain and radiation pain disappeared or relieved apparently. The mean preoperative ODI and VAS scores decreased from 78%＋3% to 18%±3%, and （8.70±11.3） to （0.65±10.48） at the final follow-up respectively. Disc space increased from a pre-oporative height of （8.76± 1.3） mm to a pest-operative of （11.8±0.6） mm. ODI, VAS and the disk space heights in all patient showed statistical significance, which revealed no statistical significance between the two groups. However, the operation time, blood loss were statistical difference between the two groups. All the patients achieved sohd union or probable union at a mean time of 5.6 months （range, 3.9-8.6）. Conclusion Posterior lumbar interbody fusion using B-Twin with MED can obtain satisfactory outcomes in the treatment of lumbar disc herniation accompa- nying degenerative instability. Single B-Twin can get similar clinical outcomes, but shorter surgical time, less blood loss, and less medical costs.
出处
《中华骨科杂志》
CAS
CSCD
北大核心
2011年第10期1110-1115,共6页
Chinese Journal of Orthopaedics
关键词
腰椎
椎间盘移位
脊柱融合术
外科手术
微创性
Lumbar vertebrae
Intervertebral disk displacement
Spinal fusion
Surgical procedures, minimally invasive
