微创减压棘突间动态固定治疗腰椎退变性疾病

Minimally invasive decompression and interspinous dynamic stabilization for lumbar degenerative diseases

摘要:

[目的] 探讨微创减压棘突间动态固定治疗腰椎退变性疾病的临床疗效。[方法] 2015 年 1 月—2017 年 10 月，42 例腰椎退变性疾病患者在全麻下行微创减压棘突间动态固定术 (IntraSPINE)，评价围手术期资料、随访及影像资料。[结果] 所有患者均顺利完成手术，术中未出现神经损伤、脑脊液漏、椎板或棘突骨折、假体置入失败等。所有患者均获得 3 年以上随访，术后 3 个月及末次随访时腰痛 VAS 评分、腿痛 VAS 评分、ODI 指数均较术前显著减少(P＜0.05)，改良 MacNab 疗效评定标准，末次随访的优良率为 95.2%(40/42)。影像方面，术后 3 个月及末次随访时，椎间隙高度(disk height, DH)和椎间孔高度 (foraminal height, FH)均较术前明显增加(P＜0.05)。随访中 1 例出现相邻节段退变，余无其他并发症。[结论]微创减压棘突间动态固定治疗腰椎退变性疾病的疗效满意。

Abstract:

[Objective] To evaluate the clinical outcomes of minimally invasive decompression and interspinous dynamic stabilization for lumbar degenerative diseases. [Methods] A retrospective study was conducted on 42 patients who received microdiscectomy and Intra- SPINE implantation through minimally invasive Quadrant channel under general anesthesia for lumbar degenerative diseases from January 2015 to October 2017. The perioperative, follow-up and radiographic documents were evaluated. [Results] All patients had operation per- formed successfully with operation time of (76.4±16.8) minutes, and blood loss of (59.1±14.5) ml, and were followed up for more than 3 years. The VAS and ODI scores significantly improved at 3 months postoperatively and the latest follow-up compared with those before operation (P＜0.05) . In addition, the excellent and good rate of clinical outcomes were marked as 95.2% based on the MacNab’s criteria at the latest fol- low-up. In terms of radiographic assessment, the intervertebral disc height (DH) and intervertebral foraminal height (FH) significantly in- creased postoperatively compared with those before operation (P＜0.05) . During the follow-up, only 1 case of them developed adjacent seg- ment degeneration, without other complications. [Conclusion] The minimally invasive decompression and interspinous dynamic stabiliza- tion does achieve satisfactory clinical outcomes in the treatment of lumbar degenerative diseases.