摘要目的 探讨扩张通道管系统(METRX X-Tube)辅助下后路腰椎椎体间融合术(PLIF)治疗下腰椎疾患的临床价值.方法 2005年5月至2006年3月,应用X-Tube辅助下微创PLIF治疗下腰椎病变患者31例,其中男性17例,女性14例;年龄38-75岁,平均54.2岁;腰椎滑脱症14例(其中Ⅰ度8例,Ⅱ度6例),椎管狭窄症8例,椎体后缘离断症5例,椎间盘突出症伴椎间隙狭窄4例.病变节段:L4,5 17例,L5～S1 13例,L3,4 1例.记录手术时间及术中出血量.每例患者术前、术后1 d及术后7 d检查生化全套,测定肌酸激酶水平变化,并与同期在本院行开放PLIF的31例患者的肌酸激酶水平变化进行比较.对所有患者进行定期随访和影像学检查,并进行Oswestry功能障碍评分.结果 31例患者手术时间140～225 min,平均(176±22)min;术中出血量270～750 ml,平均(406±96)ml.微创PLIF术后1 d肌酸激酶水平明显低于开放手术(P＜0.01).术后2例患者2枚螺钉置入位置欠佳,但无神经损伤并发症和不影响固定效果而无需翻修;1例 L4,5节段椎管狭窄症患者术后主诉左侧L5神经根支配区域麻木,经对症治疗2周后症状消失,其余患者无固定不良和神经损伤等相关并发症发生.31例均获随访,随访时间7～17个月,平均12.2个月.随访病例均经腰椎X线检查,部分病例经螺旋CT三维重建,提示手术节段均在术后半年内获得良好的节段融合.Oswestry功能障碍评分由术前平均(40.6±5.1)分降至术后平均(17.4±6.5)分,末次随访时平均(9.5±4.0)分,手术疗效优良.结论 X-Tube辅助下微创PLIF治疗下腰椎疾患具有术中出血少、创伤小、术后康复快、骨融合时间短和临床疗效确切等优点.

abstractsObjective To evaluate the clinical outcomes of minimally invasive posterior lumbar interbody fusion(PLIF)assisted by X-Tube system for the management of degenerative lumbar diseases.Methotis A total of 31 patients,17 male and 14 female with ages from 38 to 75 (average 54.2 years),underwent minimally invasive PLIF assisted by the X-Tube system from May 2005 to March 2006.The index diagnosis was lumbar spondylolisthesis in 14 cases,spinal stenosis in 8 cases,separation of the posterior ring apophysis in 5 cases,interveterbral space stenosis with disk herniation in 4 cases.Bofore operation,conservative management for at least 6 months was proved to be failure in all these patients.The operative duration and blood loss were estimated.The changes of postoperative serum level of creatinine kinase was measured as well,and compared witll the control group of 31 cases who were managed with traditional open PLIF operation during the same period at our department.The clinical functional outcomes were evaluated according to Oswestry disability questionnaire.Results The operation lasted for 140-225 min,with a mean duration of(176±22)min.Blood loss during the operation was 270-750 ml,with a mean of(406±96)ml.Postoperative serum level of creatinine kinase was obviously lower in minimally invasive PLIF cases than in the open control cases.Although 2 pedicle screws in 2 cases were not in ideal position,there was no nerve root irritation or fixation failure and hence no revision was required.One case with spinal stenosis complained of numbness in the area dominated by left L5 nerve root after operation,but the symptom was relieved within 2 weeks through conservative management.All the 31 patients were followed up for 7-17 months,with a mean duration of 12.2 months.Lumbar radiography,and three-dimentional CT reconstruction in some cases,was performed and revealed solid fusion of the surgical segments half a year after the operation.The average Oswestry scores decreased from preoperative 40.6±5.1 to 17.4±6.5 at the first postoperative day and to 9.5±4.0 at the final follow-up.The outcome of this operation were rated as excellent.Conclusions Minimally invasive PLIF assisted by X-Tube system has the characteristics of less blood loss,tissue trauma and operative time,quick recovery and bony fusion.The short-term outcomes are excellent.