单侧钉棒+可撑开腰椎后路融合器治疗腰椎间盘突出伴腰椎不稳症

摘要

目的：探讨单侧椎弓根螺钉固定+可撑开腰椎后路融合器（韩国Medyssey）植入术治疗腰椎间盘突出伴腰椎不稳症的疗效和应用价值。方法手术减压+突出髓核摘除、椎间植骨+可撑开腰椎后路融合器植入、单侧钉棒固定治疗腰椎间盘突出伴腰椎不稳症。结果本组29例获随访，时间8～14个月，平均10个月，腰腿痛症状均有好转，其中优22例，良5例，可2例，优良率：93%；复查X片均获骨性融合，平均融合时间约4～6个月。结论采用单侧钉棒固定+可撑开腰椎后路融合器植入、植骨融合治疗腰椎间盘突出伴腰椎不稳症，可有效减少骶脊肌失神经萎缩、降低医源性椎管狭窄的发生率，维持良好的椎间隙高度和腰椎的生理前凸，为椎间融合提供了良好的基础。%Objective To explore the clinical effect and application value of unilateral pedicle screw fixation combined with open posterior lumbar fusion (Korean Medyssey) implantation in the treatment of lumbar disc herniation complicated with lumbar instability. Methods Surgical decom-pression+removal of nucleus pulposus,intervertebral bone graft+open lumbar posterior intervertebral bone graft fusion device implantation,and single screw rod fixation were used to treat lumbar disc herniation complicated with lumbar instability. Results 29 cases were followed up for 8-14 months,average 10 months. The waist and leg pain symptoms were improved, in which 22 cases were excellent,5 cases were good,2 cases were fair,the excellent and good rate was 93%. X-ray reexamination showed that bony fusion,the average convergence time was about 4-6 months. Con-clusion The unilateral nail rod fixed+open lumbar posterior fusion implant and bone graft fusion in the treatment of herniation associated with lumbar instability can effectively reduce the sacral spinal muscular nerve atrophy loss,reduce the incidence of iatrogenic spinal canal stenosis,maintain good height of intervertebral disc and lumbar physiological lordosis,which provides good foundation for intervertebral fusion.