Quadrant通道下微创治疗复发性腰椎间盘突出症的近期疗效观察  

SHORT-TERM EFFECTIVENESS OF Quadrant RETRACTOR IN TREATMENT OF RECURRENT LUMBAR DISC PROTRUSION

作　　者：滕海军[1] 王亮[1] 郭志良[1] 范丽静[1] 张大海[1] 刘超[1] 王时东[1] 

机构地区：[1]解放军第89医院脊柱外科二区,山东潍坊261021

出　　处：《中国修复重建外科杂志》2011年第8期960-963,共4页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的评价Quadrant通道下微创治疗复发性腰椎间盘突出症的疗效。方法 2008年7月-2010年3月,对18例复发性腰椎间盘突出症患者采用Quadrant通道下椎间盘突出髓核摘除术治疗。其中男13例,女5例;年龄35～67岁,平均43岁。手术节段:L4、5 6例,L5、S1 12例。首次手术至复发时间为12～120个月,平均42.8个月。患者均行X线片、CT及MRI检查确诊原椎间盘再次突出。末次随访时采用疼痛视觉模拟评分(VAS)和改良MacNab标准评定患者症状改善情况。结果手术时间40～80 min,平均60 min;术中出血量80～120 mL,平均100 mL。手术切口均Ⅰ期愈合;术中2例发生脑脊液漏,未行修补,术后3 d拔除引流片后切口愈合。术后无椎间隙感染、神经损伤、定位错误等并发症发生。18例均获随访,随访时间12～30个月,平均22个月。末次随访时按改良MacNab标准评价疗效,获优12例,良6例。末次随访时,腿痛VAS评分由术前的(7.3±2.2)分降至(2.0±1.3)分,差异有统计学意义(t=11.08,P=0.00)。随访期间无复发。结论 Quadrant通道下椎间盘突出髓核摘除术具有创伤小、并发症少等优点,是治疗复发性腰椎间盘突出症的一种安全有效的微创手术方法。Objective To investigate the effectiveness of Quadrant retractor for the treatment of recurrent lumbar disc protrusion. Methods Between July 2008 and March 2010, 18 cases of recurrent lumbar disc protrusion were treated with Quadrant. There were 13 males and 5 females with an average age of 43 years （range, 35-67 years）. Involved segments included L4, 5 in 6 cases and L5, S1 in 12 cases. The time between first operation and recurrence was 12-120 months （mean, 42.8 months）. Before operation, radiological evaluation including X-ray, CT, and MRI were performed. Visual analogue scale （VAS） score and modified MacNab criteria were used to evaluate the effectiveness. Results The operation time was 40-80 minutes （mean, 60 minutes）, and the amount of blood loss was 80-120 mL （mean, 100 mL）. All operations were performed successfully, and no complication of infection and nerve injury occurred. Incisions healed by first intention. Cerebrospinal fluid leakage occurred in 2 cases and was cured at 3 days after operation by removal of drainage. Eighteen patients were followed up 12-30 months （mean, 22 months）. The VAS score of leg pain was decreased from 7.3±2.2 preoperatively to 2.0±1.3 at the final follow-up, showing significant difference （t=-11.08, P=0.00）. According to modified MacNab criteria, the results were excellent in 12 patients and good in 6 patients. No recurrence was found during follow-up. Conclusion Discectomy via Quadrant retractor is a safe and effective minimally invasive surgical technique in treating recurrent lumbar disc protrusion.

关 键 词：QUADRANT通道 髓核摘除术 微创技术 复发性腰椎间盘突出症 

分 类 号：R687.3[医药卫生—骨科学]