摘要
目的探讨通道辅助下经关节突减压结合动态稳定系统（Dynesys）治疗腰椎退行性疾病的临床疗效。方法选取2011年9月-2013年9月在宜昌市第二人民医院应用通道辅助下经关节突减压结合Dynesys螺钉固定治疗的腰椎退行性疾病患者36例，男20例，女16例；年龄31～67岁，平均年龄为（45±10）岁。其中腰椎管狭窄症14例，腰椎间盘突出症22例；病变累及1个节段28例，2个节段8例。手术先采用肌间隙入路于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，切除椎体后缘骨赘和突出的椎间盘，扩大中央椎管和神经根管的管径。减压满意后采用常规方法完成Dynesys螺钉固定。记录患者的手术时间、术中出血量、术后引流量、拔除引流管的时间和术后下床活动时间。术前、术后和末次随访时根据疼痛视觉模拟评分（VAS评分）、Oswestry功能障碍指数（ODI）评估临床疗效，并根据X线片观察内固定情况（包括内固定位置、有无断裂等）。结果本组患者的手术时间为（125±34）min，术中出血量为（274±45）mL，术后引流量为（152±55）mL，平均拔除引流管的时间为术后（2．7±0．7）d，术后下活动床时间为术后（5．9±1．3）d。术前、术后和末次随访时的疼痛VAS评分分别为（7．41±1．19）、（2．44±1．46）、（2．25±1．50）分，0D1分别为（66．24±16．59）、（23．59±12．23）和（20．44±10．27）分。术后和末次随访时的疼痛VAS评分和ODI均显著低于术前（P值均〈0．05），术后与末次随访时的疼痛VAs评分和ODI的差异均无统计学意义（P值均〉0．05）。术后6个月随访X线片示，所有患者均无腰椎不稳征象，椎弓根钉棒无松动、断裂、变形。结论通道辅助下经关节突减压结合Dynesys螺钉固定治疗轻中度腰椎退行性疾病，可有效减少手术创伤，临�
Objective To investigate the clinical effects of dynamic neutralization system for the spine （Dynesys system） combined with transfacet decompression via extendable retractor for lumbar degenerative diseases. Methods From September 2011 to September 2013, 36 patients suffering from lumbar degenerative disease were treated surgically in our hospital. There were 20 males and 16 females with an average age of （45±10） years （range, 31 -67 years）. Preoperative diagnosis included lumbar spinal stenosis in 14 cases and lumbar intervertebral disc herniation in 22 cases. Single segment was involved in 28 cases and two segments were involved in 8 cases. Posterolateral fixation with Dynesys pedicle screws via extendable retractor was performed, and then part of the facet joint and thickened ligamentum flavum were resected. The intervertebral vertebral foramen was exposed unilaterally. After satisfactory decompression of the nerve root, Dynesys was performed according to normal procedure. The operation time, intraoperative blood loss. postoperative drainage, time of extubation and early postoperative activities were all recorded. Visual analogue scale （VAS） score and Oswestry disability index （ODI） were applied to evaluate the therapeutic effect before, after surgery and at the last follow- up. The outcome of internal fixation including location and presence of disrupt were observed by X-ray scan. Results The average operation time was （125＋ 34） min, and the blood loss during operation and drainage after operation were （274 ±45） mL and （152±55） mL, respectively. The average time of removal of the drainage tube was （2.7 ±0.7） d. Patients could walk at （5.9 ± 1.3） d after surgery. VAS and ODI scores after surgery （2.44 ±1.46, 23.59± 12.23） and at the final follow-up （2.25 ±1.50, 20.44±10.27） were significantly lower than preoperative ones （7.41 ± 1.19, 66.24＋ 16.59, all P〈0.05）. There was no significant difference in the VAS or ODI score between postoperative a
出处
《上海医学》
CAS
CSCD
北大核心
2016年第9期536-540,I0001,共6页
Shanghai Medical Journal
关键词
腰椎退行性疾病
通道
动态固定
减压
Lumbar degenerative disease
Extendable retractor
Dynamic fixation
Decompression
