梁博伟;李宁宁;胡朝晖;孙宏志;唐运鹏;

• 1:广西医科大学第五附属医院柳州市人民医院骨科

摘要(Abstract)：

[目的]比较传统正中入路双侧椎弓根螺钉固定(A组)与多裂肌间隙入路单侧椎弓根螺钉固定(B组)治疗单节段特殊类型腰椎间盘突出症(special type lumbar disc herniation,STLDH)的临床效果。[方法]2007年3月～2009年3月采用椎弓根螺钉固定联合经椎间孔腰椎椎体间融合术治疗单节段STLDH患者73例,其中A组41例,B组32例。比较两组的手术创伤、全身炎性反应、临床疗效、融合率及椎旁肌损伤。[结果]A组随访时间平均2.8(2.2～4.1)年,B组2.7(2.1～4.2)年。两组手术时间、术中出血量、术后引流量、切口长度、术后3 d内的最高体温、术后24 h外周血的白细胞和C反应蛋白以及肌酸激酶、术后6 d C反应蛋白的比较差异有显著性(P<0.05),B组优于A组。末次随访时,两组的ODI及VAS评分均较术前明显改善(P<0.05),腿痛VAS评分差异无显著性(P>0.05),而ODI及腰痛VAS评分差异有显著性(P<0.05),B组优于A组;A组和B组椎间坚强融合率分别为92.7%、93.8%,差异无显著性(P>0.05);A组和B组多裂肌萎缩比分别为(36±14)%、(16±7)%,差异有显著性(P<0.05)。[结论]两种手术方法均能有效治疗单节段STLDH;与传统正中入路双侧椎弓根螺钉固定术相比,多裂肌间隙入路单侧椎弓根螺钉固定术具有手术创伤小、术后全身炎性反应轻、椎旁肌损伤小及术后腰背痛程度较轻的优势。

关键词(KeyWords)： 多裂肌间隙入路;腰椎间盘突出症;椎弓根螺钉固定;经椎间孔的腰椎体间融合术

Abstract:

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基金项目(Foundation):

作者(Author): 梁博伟;李宁宁;胡朝晖;孙宏志;唐运鹏;

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参考文献(References)：

• [1]李佛保,郑召民.腰椎间盘突出症手术治疗有必要放置椎间融合器吗[J].中国矫形外科杂志,2007,17:1359-1360.
• [2]Kotil K,Tunckale T,Tatar Z,et al.Serum creatine phosphokinaseactivity and histological changes in the multifidus muscle:a prospec-tive randomized controlled comparative study of discectomy with orwithout retraction[J].J Neurosurg Spine,2007,2:121-125.
• [3]Kim CW.Scientific basis of minimally invasive spine surgery:pre-vention of multifidus muscle injury during posterior lumbar surgery[J].Spine,2010,26:281-286.
• [4]王建,周跃,初同伟,等.内窥镜下单侧神经减压椎间融合椎弓根螺钉固定的临床应用[J].中国矫形外科杂志,2008,19:1445-1448.
• [5]Fan S,Hu Z,Zhao F,et al.Multifidus muscle changes and clinicaleffects of one-level posterior lumbar interbody fusion:minimallyinvasive procedure versus conventional open approach[J].EurSpine J,2010,2:316-324.
• [6]Suk SI,Lee CK,Kim WJ,et al.Adding posterior lumbar interbody fu-sion to pedicle screw fixation and posterolateral fusion after decompres-sion in spondylolytic spondylolisthesis[J].Spine,1997,2:210-220.
• [7]Park P,Garton HJ,Gala VC,et al.Adjacent segment disease afterlumbar or lumbosacral fusion:review of the literature[J].Spine,2004,17:1938-1944.
• [8]Suk KS,Lee HM,Kim NH,et al.Unilateral versus bilateral pedi-cle screw fixation in lumbar spinal fusion[J].Spine,2000,14:1843-1847.
• [9]唐三元,杨辉,付海鹰,等.创伤骨折后多项血生化指标连续性检测的临床意义[J].中国矫形外科杂志,2008,2:84-88.
• [10]Slucky AV,Brodke DS,Bachus KN,et al.Less invasive posteriorfixation method following transforaminal lumbar interbody fusion:abiomechanical analysis[J].Spine,2006,1:78-85.
• [11]董健文,邱奕雁,赵卫东,等.单侧椎弓根钉棒固定单节段腰椎及其邻近节段生物力学研究[J].中国临床解剖学杂志,2010,1:85-89.
• [12]Schleicher P,Beth P,Ottenbacher A,et al.Biomechanical evaluationof different asymmetrical posterior stabilization methods for minimal-ly invasive transforaminal lumbar interbody fusion[J].J NeurosurgSpine,2008,4:363-371.
• [13]Kepler CK,Sharma AK,Huang RC.Lateral transpsoas interbodyfusion(LTIF)with plate fixation and unilateral pedicle screws:apreliminary report[J].J Spinal Disord Tech,2011,6:363-367.
• [14]Holly LT,Schwender JD,Rouben DP,et al.Minimally invasivetransforaminal lumbar interbody fusion:indications,technique,andcomplications[J].Neurosurg Focus,2006,3:6.
• [15]Karikari IO,Isaacs RE.Minimally invasive transforaminal lumbarinterbody fusion:a review of techniques and outcomes[J].Spine,2010,26:294-301.