腰椎间盘突出症合并腰椎不稳治疗中Quadrant系统的应用  

Quadrant System in lumbar disc herniation treatment of lumbar instability

作　　者：魏劲松[1] 曾荣[1] 陈思圆[1] 魏波[1] 林颢[1] 

机构地区：[1]广东医学院附属医院骨科,广东省湛江市524000

出　　处：《中国组织工程研究》2013年第30期5563-5568,共6页Chinese Journal of Tissue Engineering Research

摘　　要：背景:腰椎间盘突出症手术后仍有10%-30%的患者症状缓解不明显,统称为腰椎术后失败综合征,而腰椎不稳是其中的一个重要原因。目的:探讨Quadrant系统下后路腰椎管减压、椎间盘摘除、椎间融合和椎弓根螺钉固定治疗腰椎间盘突出症合并腰椎不稳可行性和有效性。方法:2011年12月至2012年10月应用Quadrant系统行后路腰椎管减压、椎间盘摘除、椎间植骨加融合器置入、椎弓根螺钉固定治疗腰椎间盘突出症合并腰椎不稳患者62例,男38例,女24例。年龄37-69岁,平均年龄为53.7岁,治疗后随访评价治疗效果。结果与结论:手术时间为90-210min,平均时间145min。术中失血量50-300mL,平均失血量120mL。治疗后住院时间5-9d,平均住院时间6d。手术切口均一期愈合。随访3-10个月,平均7.2个月。JOA评分治疗前为(10.25±2.34)分,治疗后1个月及末次随访时分别为(18.31±3.12)分和(25.35±2.61)分。与治疗前比较均有显著性差异(P<0.01)。目测类比评分治疗前为(8.24±1.15)分,治疗后1个月及末次随访时分别为(2.97±1.12)分和(1.13±0.39)分。与治疗前比较均有显著性差异(P<0.01)。末次随访时采用改良Macnab标准评价临床效果,优53例,良9例。证明Quadrant系统下后路腰椎管减压、椎间盘摘除、椎间融合和椎弓根螺钉固定治疗腰椎间盘突出症合并腰椎不稳,是一种安全有效的微创治疗方法。BACKGROUND：There are stil about 10%-30%of patients presenting no obvious improvement of symptoms after lumbar disc herniation surgery, which are col ectively known as the lumbar spine post-surgery failure syndrome, and lumbar instability is one of the important reasons. OBJECTIVE：To evaluate the feasibility and efficacy of surgery including posterior lumbar spinal canal decompression, intervertebral disc resection, lumbar interbody fusion, and pedicle screw fixation on lumbar intervertebral disc protrusion concurring lumbar instability via MAST Quadrant retractor. METHODS：From December 2011 to October 2012, 62 cases of lumbar intervertebral disc protrusion concurring lumbar instability were treated with posterior lumbar spinal canal decompression, intervertebral disc resection, lumbar interbody fusion, and pedicle screw fixation via MAST Quadrant retractor. There were 38 female and 24 male ranging in age from 37 to 69 years （average 53.7 years）. After operation, al patients were fol owed-up to evaluate the effect of the treatment. RESULTS AND CONCLUSION：The operative time was 90-210 minutes, average 145 minutes, and the amount of blood loss was 50-300 mL, average 120 mL. The hospitalization time was 5-9 days, average 6 days. Al incisions healed by first intention. Al patients were fol owed up 7.2 months on average （from 3 to 10 months）. The preoperative JOA score was （10.25±2.34） points. The postoperative JOA score decreased to （18.31±3.12） points at the fol ow-up after 1 month and （25.35±2.61） points at the last fol ow-up, showing significant difference when compared with preoperative score （P〈0.01）. The preoperative VAS score was （8.24±1.15） points. The postoperative VAS score decreased to （2.97±1.12） points after 1 month and （1.13±0.39） points at the last fol ow-up, showing significant difference when compared with preoperative score （P〈0.01）. According to reforming Macnab standard, the results were excel ent in 53 cases and good in 9 cases at the last

关 键 词：骨关节植入物 骨与关节学术探讨 QUADRANT系统 腰椎间盘突出症 腰椎不稳 椎弓根钉固定 植骨融合 腰椎管减压 椎间盘摘除 

分 类 号：R318[医药卫生—生物医学工程]