摘要目的 探讨通道下经肌间隙入路单侧椎弓根螺钉联合对侧椎板关节突螺钉并椎间植骨融合术治疗老年人腰椎退行性疾病的可行性和近期疗效. 方法 2015年1月至2016年6月82例老年人腰椎退行性疾病患者;腰椎椎管狭窄症25例,腰椎退行性不稳症42例,巨大型腰椎间盘突出症13例,腰椎间盘突出症术后原位复发2例;单节段病例69例,双节段病变13例.术后进行围手术期评估、影像学评估和临床疗效评估,并对手术并发症进行分析. 结果 单节段病例切口长度(2.6±0.4)cm,双节段(4.4±0.5)cm.手术时间(98.3±19.6)min,术中出血量(232.2±25.8)ml.椎间隙高度末次随访时较术前明显增加(P＜0.05),椎间隙高度恢复良好并获得较好维持,无内固定松动、断裂及Cage移位.腰椎冠状面Cobb角末次随访时较术前显著减小(P＜0.05),矢状面Cobb角末次随访时较术前显著增加(P＜0.05).术后12个月MRI上多裂肌面积和等级改变较术前无统计学差异.72例获12～18个月随访,平均16.8个月,67例椎间融合,融合率93.1％(67/72).日本骨科协会(JOA)评分末次随访(25.8±1.7)分,较术前(10.6±1.3)分提高,优良率为88.9％.Oswestry功能障碍指数(ODI)由术前(50.9±21.6)分降至随访时的(9.6±4.8)分(P＜0.05).手术切口I期愈合78例,术后出现切口表皮部分坏死3例,术中硬脊膜撕裂1例,神经根损伤1例.术中、术后无心脑血管意外. 结论 通道下经肌间隙入路联合固定并椎间融合术治疗老年人腰椎退行性疾病近期疗效较好,具有创伤小,出血少,术后恢复快,融合率高,临床疗效显著等优点,但中长期临床疗效尚需进一步临床研究.

abstractsObjective To examine the feasibility and early effects of unilateral pedicle screw fixation in combination with contralateral translaminar facet screw fixation plus interbody fusion through the channel-assisted muscle-splitting approach for the treatment of degenerative lumbar spine diseases in elderly patients.Methods A total of 82 elderly patients with degenerative lumbar spine diseases received treatment between January 2015 and June 2016.Of these patients,25 had lumbar spinal stenosis,42 had degenerative lumbar instability,13 had giant lumbar disc herniation,and two had recurrent lumbar disc herniation;There were 69 cases of single segment and 13 cases of double segment lesions.Perioperative evaluation,imaging evaluation,and clinical evaluation were performed,and surgical complications were analyzed.Results The average length of incision was (2.6 ± 0.4) cm in cases of single segment lesions and (4.4±0.5) cm in cases of two segment lesions.The mean operation time was (98.3±19.6) minutes and peri-operation blood loss was (232.2±25.8) ml.The post-operation height of the intervertebral disc space significantly increased at the last follow-up(P ＜ 0.05);the height of the intervertebral disc space was restored and well maintained with internal fixation showing no loosening,breakage or Cage shift.The post-operation lumbar coronal Cobb angle decreased(P＜0.05)while the sagittal Cobb angle increased(P＜0.05)at the last follow-up.There was no significant difference in the area and grade of the multifidus muscle on MRI 12 months after operation.Seventy-two patients were followed up for 12-18 months (mean =16.8 months),and there were 67 cases of intervertebral fusion (93.1％).The last follow-up showed a Japanese Orthopaedic Association(JOA) score of (25.8 ± 1.7),which was significantly higher than the pre-operation score (10.6±1.3),with an excellence rate of 88.9 ％.The Oswestry Disability Index score was significantly reduced,from (50.9±21.6) at pre-operation to (9.6± 4.8) at the last follow-up.There were 78 patients with primary wound healing,three cases of superficial wound necrosis,one case of dural tear,and one case of nerve root injury.No cardiovascular or cerebrovascular incident was observed during or after operation.Conclusions Combined pedicle/facet screw fixation plus interbody fusion through the channel-assisted muscle-splitting approach shows satisfactory short-term effects when used for the treatment of degenerative lumbar spine diseases in the elderly and possesses advantages such as minimal invasiveness,limited bleeding,quick recovery,high fusion rates and significantly improved clinical outcomes.However,further clinical studies are required to assess its medium-and long-term efficacy.