Quadrant通道下TLIF术治疗复发性腰椎间盘突出症的疗效分析  

Transforaminal lumbar interbody fusion via Quadrant invasive system for recurrent lumbar disc herniation: an analysis of surgical outcome

作　　者：王志荣 陆爱清[1] 杨惠林[2] 王素春[1] 陈勇[1] 陈国平[1] 

机构地区：[1]南京中医药大学附属张家港医院骨科,张家港市215600 [2]苏州大学附属第一医院骨科,苏州市215006

出　　处：《中国脊柱脊髓杂志》2014年第2期121-126,共6页Chinese Journal of Spine and Spinal Cord

基　　金：江苏省苏州市科技发展项目(SYSD2011002)

摘　　要：目的：探讨后路原皮肤切口双侧肌间隙人路经Quadrant通道下TLIF术（transforaminallumbarinter-bodyfusion）治疗复发性腰椎间盘突出症（recurrentlumbardischerniation，RLDH）的临床效果。方法：2009年1月～2011年12月共治疗RLDH患者22例，年龄为35～65岁，平均51．2岁。病变节段L4／516例．L5／S16例。其中开窗减压髓核摘除术后复发10例，内窥镜下髓核摘除术后复发8例，半椎板减压髓核摘除术后复发4例。均采用后路原切口双侧肌间隙人路，经Quadrant通道下行微创TLIF术。采用JOA（29分法）功能评分对患者再次手术前、手术后1年临床疗效进行评估，并计算改善率。采用Suk法评估椎间植骨融合情况。结果：22患者均顺利完成手术，无脑脊液漏，无神经根损伤。22患者均获得随访，随访时间为18～37个月，平均24个月。术前JOA评分为9．8±1．4分，术后1年JOA评分为24．5±1．2分，与术前比较差异有统计学意义（P〈0．05）。根据改善率评估临床效果，其中优20例，良2例。随访期内植骨均融合，融合时间5～12个月，平均9-3个月，无椎弓根螺钉断裂和融合器移位。结论：后路原皮肤切口双侧肌间隙人路经Quadrant通道下TLIF术是一种微创治疗RLDH的可行方法。Objectives： To investigate the surgical outcome of minimal invasive transforaminal lumbar in- terbody fusion via bilateral paramedian approach under Quadrant invasive system for recurrent lumbar disc herniation. Methods： From January 2009 to December 2011, the clinical data of 22 patients（average age 51.2 years, ranging 35-65 years old） suffering from recurrent lumbar disc herniation （10 cases under window of laminar, 8 cases under MED, 4 cases under hemilaminectomy） were reviewed retrospectively. A total of 22 segments was involved, including IA/5 in 16 cases, L5/S1 in 6 cases. All 22 cases underwent minimal inva- sive transforaminal lumbar interbody fusion via bilateral paramedian approach under Quadrant invasive system. JOA（29） score was used to evaluate the pre-and post-revision operation（12 months） outcome as well as the improvement rate. 5uk＇s method was used to evaluate the lumbar interbody fusion. Results： The operations were completed successfully in all the 22 patients, and no cerebrospinal fluid leakage and nerve root injury were noted. All patients were followed up for 18-37 months（mean, 24 months）. The mean JOA score at pre- operation and 12 months after operation was 9.8±1.4 and 24.5±1.2 respectively, which showed statistical sig- nificance（P〈0.05）. Based on the improvement rate, there were 20 excellent and 2 good. All cases got bony fusion with the fusion time of 5-12 months（mean, 9.3 months）. No instrument failure was noted. Conclusions： Minimal invasive transforaminal lumbar interbody fusion via bilateral paramedian approach under Quadrant invasive system is reliable and effective for the treatment of recurrent lumbar disc herniation.

关 键 词：腰椎间盘突出症 复发性 TLIF QUADRANT通道 疗效 

分 类 号：R681.5[医药卫生—骨科学]