[摘要]  目的：探讨椎间盘镜下椎管减压、椎间植骨融合治疗腰椎失稳症的临床疗效。方法：2006年7月～2008年12月共收治退变性腰椎失稳症患者48例，患者均有持续性腰痛，伴有双侧臀部、双侧或一侧下肢疼痛、麻木，均有间歇性跛行、腰部屈伸活动受限。腰椎动力片示均为单节段失稳，椎间水平移位≥4mm或角度≥11°，但滑移不超过Ⅰ度。均采用内窥镜下经椎板间隙入路椎管减压、经椎间孔入路椎体间自体骨粒、椎间融合器置入椎体间融合术。术后2周（出院时）拍腰椎正侧位片，术后每3个月复查X线片。按照Macnab标准评价疗效，随访观察近期治疗效果。结果：手术时间70～150min，平均95min；出血量110～210ml，平均150ml。随访6～18个月，平均12个月。术后症状及体征均不同程度缓解，术中、术后均无任何并发症发生。末次随访时按照Macnab标准进行疗效评定：优24例，良20例，可4例。X线检查未见cage移位、下沉，37例随访超过9个月的病例均见椎间隙变模糊，过伸过屈侧位片椎体间无移位，提示可能已融合或正在融合，但所有患者均未观察到骨小梁完全通过椎体间上下终板、椎间隙消失。结论：内窥镜下椎管减压及椎间融合术治疗退变性椎间失稳症具有早期疗效满意、创伤小等优点，长期疗效及融合情况需进一步随访观察。内蒙古医科大学第二附属医院骨科银和平

The short term outcome of decompression and interbody fusion by Microendoscopic for degenerative lumbar instability

YIN Heping , Wu Yimin, Li shuwen, et al.

【Abstract】Objective To discuss the clinical effect of decompression and interbody fusion by Microendoscopic . Method From July 2006 to December 2008,48 patients with degenerative lumbar instability syndrome were treated by Microendoscopic,during which the decompression by vertebral plate space approach and the interbody fusion by intervertebral foramina approach were performed. All the patient’s  clinical manifestation was persistence pain of low back and two side haunch with one or two legs. At the same time, all the patient complained that their haunch and one or two leg were insensibility. All the patients have intermittent lameness and limitation of flexion and extention of lumbar. The dynamic X-ray show that the displacement of vertebrae was more than 4mm or the change of angle of the two body was more than 11 degree.But the displacement was not more than Ⅰ degree. The first X-ray examination was performed at 2 weeks after the operation. During the followed up　period, the X-ray were performed every 3 months. The clinical short term outcome outcomes were assessed by Macnab criteria. Result All the cases were finished successfully and were followed up for a period of 6-18 months(means 12 months). The operative time was 70-150 minutes(means 95 minutes), and the blood loss was 110-210ml(means 150 ml). No complication occurred. The clinical outcomes were assessed by Macnab criteria. 24 cases was excellent , 20 cases was good and 4 cases was fair. X-ray show that no cage displacement and sink in all cases. 37 cases which were followed more than 9 months were found the verteberal place was blured and no displacement on the dynamic X-ray pictures which show the body have been fused or been fuseding.The phenomenon of bone trabecula went through the end plate and disapearing of intervertebral space was not be observed. Conclusion The technique of decompression and fusion under Microendoscopic can provide a minimally invasive and satisfactory treatment result for degenerative lumbar instability syndrome.

【Key words】lumbar instability syndrome; Microendoscopy; Operation

【Author’s address】Department of minimally invasive spine surgery of the Second Affiliated Hospital of Inner Mongolia Medical College，Huhhot，010030，china