Luxor通道下微创TLIF术治疗腰椎滑脱症的临床应用

发布时间：2018-02-10 10:57

本文关键词： 脊柱植入物可扩张通道腰椎滑脱微创　出处：《郑州大学》2015年硕士论文　论文类型：学位论文

【摘要】：背景:腰椎滑脱症(spondylolisthesis)是脊柱滑脱中最常见的类型,是指腰椎某一节段相对于其临近的节段出现出现位移,椎体滑移可以向前、后及侧方滑移。其临床症状的机制较为复杂,多为:①峡部裂引起的椎弓活动异常;②滑脱节段序列错误;③阶段性不稳;④峡部裂处纤维软骨组织压迫神经根;⑤合并椎间盘突出及椎管狭窄;⑥小关节退变等;手术目的在于恢复脊柱矢状面上生理曲度,重建脊柱三柱结构的连续性,恢复椎间隙高度,确保滑脱节段的融合避免再次滑脱[1]。过去手术常采用原位融合,例如椎间植骨融合或横突间植骨融合,术后常有再次滑脱倾向;近年,脊柱生物力学的发展及新型脊柱内固定系统的研发及应用,对于滑脱椎体的复位、融合有了新的认识,后路腰椎椎间植骨融合术(posterior lumbai interbody fusion,PLIF)联合后路椎弓根螺钉内固定,椎板切除、神经根松解扩大减压cage置入术被广泛应用和推广,并取得了一定的临床疗效。但手术对椎旁肌肉的广泛剥离、术中切除棘突、棘间韧带、椎板等后纵韧带复合体,对脊柱后柱的破坏较大,造成脊柱稳定性下降和术后患者遗留长期腰背痛,影响患者生活质量[2-5]。随着微创技术的发展,Luxor微创通道系统辅助下经椎旁多裂肌最长肌间隙入路,微创治疗腰椎退行性变的手术方式得到广泛应用,其具有创伤小,术中无需广泛剥离椎旁肌肉、切除后纵韧带复合体;术后恢复快,并发症少的特点。目的:观察Luxor通道系统辅助下经多裂肌最长肌间隙入路微创治疗腰椎滑脱的早期的临床疗效。方法:回顾性分析2012年10月-2014年2月期间,我院骨科收治的采用Luxor通道下TLIF术治疗腰椎滑脱患者36例,观察术后3个月、一年患者ODI评分、VAS评分改善率,了解椎间融合情况及内固定有无松脱、断裂等情况。结果及结论:所有患者手术顺利完成,无脑脊液漏及神经损伤,术后1例切口感染、抗生素治疗10天后感染控制,余患者切口均甲级愈合;所有患者均获得随访,术后术后3个月及1年随访时ODI评分均较术前明显恢复,差异有统计学意义(P0.05),术后3个月及1年时两者ODI[6]评分差异无统计学意义(P0.05);随访1年时改善率为(65.3±14.8)%。术后3个月及1年随访时VAS评分均较术前明显改善,差异有统计学意义(P0.05),术后3个月与1年随访时比较差异无统计学意义(P0.05);术后1年随访时改善率为(58.2±12.0)%。Luxor通道下TLIF术治疗腰椎滑脱为微创治疗腰椎滑脱的可行的手术方式,不仅能有效的纠正腰椎滑脱畸形、维持脊柱的生物力学稳定、改善患者症状,还能降低患者术后腰背痛的发生率,获得较高的生活质量。
[Abstract]:Background: spondylolisthesis (spondylolisthesis) is the most common type of spondylolisthesis. It refers to the displacement of a segment of the lumbar vertebrae relative to the adjacent segment of the spondylolisthesis, which can slip forward, backward and lateral. The mechanism of its clinical symptoms is complicated. Most of them were due to abnormal pedicle activity caused by 1 / 1 isthmic fissure. (2) sequence errors in the segment of spondylolisthesis; (3) staggered instability; (3) compression of fibrous chondrocytes in the fissure of the isthmus with disc herniation and degeneration of 6 facet joints in spinal canal stenosis. The purpose of the operation is to restore the physiological curvature on the sagittal plane of the spine, to reconstruct the continuity of the three-column structure of the spine, to restore the height of the intervertebral space, and to ensure that the fusion of the segments of the slippage does not occur again [1]. For example, intervertebral bone graft fusion or intertransverse bone graft fusion often tends to slip again after surgery. In recent years, the development of spinal biomechanics and the development and application of new spinal internal fixation systems have gained a new understanding of the reduction and fusion of spondylolisthesis. Posterior lumbai interbody fusion combined with posterior pedicle screw fixation, laminectomy, nerve root decompression and cage implantation are widely used and popularized. But the extensive exfoliation of paravertebral muscles, the removal of spinous process, interspinous ligament, laminae and other posterior longitudinal ligamentum complex, which destroyed the posterior column of spinal column. With the development of minimally invasive technique, a Luxor minimally invasive channel system assisted approach to the longest muscle space of paraspinal polyfissure muscle was performed, which resulted in the reduction of spinal stability and long-term low back pain. Minimally invasive treatment of lumbar degenerative degeneration has been widely used, its trauma is small, there is no need for extensive exfoliation of the paraspinal muscles, resection of the posterior longitudinal ligament complex, the postoperative recovery is fast, Objective: to observe the early clinical effect of minimally invasive approach to lumbar spondylolisthesis via the longest intermuscular approach of polyfissure assisted by Luxor channel system. Methods: from October 2012 to February 2014, the clinical effects of lumbar spondylolisthesis were retrospectively analyzed. 36 cases of lumbar spondylolisthesis were treated with TLIF under Luxor channel in our orthopedic department. The improvement rate of ODI score was observed in 3 months and one year after operation, and the intervertebral fusion and internal fixation were observed. Results and conclusion: no cerebrospinal fluid leakage and nerve injury were successfully completed in all patients. Infection was controlled in 1 case of incision infection 10 days after antibiotic treatment. After 3 months and 1 year follow-up, the ODI scores were significantly recovered compared with those before operation. The difference was statistically significant (P 0.05). There was no significant difference in ODI [6] scores between the two groups at 3 months and 1 year postoperatively, and the improvement rate was 65.3 卤14.8% at 1 year follow-up. The VAS scores at 3 months and 1 year follow-up were significantly improved compared with those before operation. The difference was statistically significant (P 0.05), and there was no significant difference between 3 months after operation and 1 year follow-up (P 0.05), and the improvement rate at 1 year follow-up was 58.2 卤12.0%. The feasible operative method for lumbar spondylolisthesis was treated with TLIF under Luxor channel for minimally invasive treatment of lumbar spondylolisthesis. It can not only effectively correct the lumbar spondylolisthesis deformity, maintain the biomechanical stability of the spine, improve the symptoms of the patients, but also reduce the incidence of postoperative low back pain, and obtain a higher quality of life.
【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.3

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