Quadrant通道结合经皮椎弓根螺钉固定治疗腰椎间盘突出症  

Clinical analysis of lumbar intervertebral disc protrusion treated by percutaneous pedicle screw fixation combined with quadrant channel

作　　者：付美清[1] 雷雪[1] 赵敏[1] 周江军[1] 杨俊[1] 史柏娜[1] 肖春林[1] 

机构地区：[1]解放军第184医院骨科,南京军区脊柱外科诊疗中心,江西鹰潭335000

出　　处：《颈腰痛杂志》2016年第4期276-280,共5页The Journal of Cervicodynia and Lumbodynia

基　　金：南京军区医学科技创新基金(编号:12MA049)

摘　　要：目的探讨应用Quadrant通道结合经皮椎弓根螺钉固定技术治疗腰椎间盘突出症的临床疗效。方法2011-10—2014-02，将符合纳入标准的96例患者随机分为两组，微创组：48例，采用Quadrant通道结合经皮椎弓根螺钉固定技术；传统手术组：48例，行后路切开椎弓根钉固定融合术。术后及随访时复查腰椎X线及CT，评估植入螺钉的位置及融合率，统计手术时间、术中出血量、切口总长度，术后肌酸激酶变化，以及下地活动时间、住院时间、临床疗效、并发症等方面，并进行比较分析。结果所有患者随访10-22月，平均（15±2）个月，两组植入螺钉的位置及融合率、手术时间、总切口长度、术后1年VAS、ODI评分方面比较，差异无统计学意义（P〉0．05）；但术中出血量，术后肌酸激酶变化、下地活动时间、住院时间及术后第3天VAS评分方面比较，微创组优于传统手术组，两组差异有统计学意义（P〈0．05）。两组病例均未出现脑脊液漏、神经损伤等并发症。结论应用Quadrant通道结合经皮椎弓根螺钉固定技术治疗腰椎间盘突出症，较传统融合方法具有创伤小、出血少、组织损伤轻、术后恢复快等优点。Objective To explore the clinical effect of percutaneous pedicle screw fixation combined with quadrant channel in the treatment of lumbar intervertebral disc protrusion. Meth- ods Ninety-five patients who met inclusion criteria were divided into two groups randomly. Fourty-nine patients in minimally invasive group were treated with percutaneous pedicle screw fixation combined with quadrant channel. Fourty-six patients in traditional operation group were treated by posterior pedicle screw fixation and fusion. To compare the X-ray and CT of lumbar spine after operation and clinical follow-up, position of implant screws,fusion rate,operating time, blood loss, total length of incision, kinase change after operation, ambulation time, hospital stay, clinical efficacy and complications. Results All patients were followed up for 10-22 months,the average follow-up time was 15 months. There were no significant differences in position of implant screws , fusion rate, operating time, total length of incision,score of VAS and ODI one year after operation compared with traditional operation group（P〉0.05）. There were significant differences in blood loss, kinase change after operation, ambulation time, hospital stay, VAS score three days after operation compared with traditional operation group （P〈0.05）. There were no cerebrospinal fluid （CSF） leaks and nerve injury in two groups. Conclusion Compared with traditional operation, pereutaneous pedicle screw fixation combined with quadrant channel in the treatment of lumbar intervertebral disc protrusion has some advantages, such as fewer trauma,less blood, minor tissue injury, rapid recuperation.

关 键 词：QUADRANT通道 经皮椎弓根螺钉 传统融合 腰椎间盘突出症 

分 类 号：R687.32[医药卫生—骨科学] R681.53[医药卫生—外科学]