多裂肌间隙入路单侧椎弓根螺钉固定治疗特殊类型腰椎间盘突出症Surgical treatment for special type of lumbar disc herniation by transmultifidus approach and unilateral pedicle screws fixation
梁博伟;李宁宁;胡朝晖;孙宏志;唐运鹏;
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
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):
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