微创通道下简化治疗伴邻近节段退变腰椎滑脱症的疗效分析  

Analysis of clinical outcomes of simplified treatment of lumbar spondylolisthesis with adjacent segment degeneration by MAST Quadrant

作　　者：唐建华[1] 赵丽丽[1] 黄春明[1] 钟诚凡[1] 李小川[1] 何雨生[2] 

机构地区：[1]高州市人民医院骨科,广东高州525200 [2]郴州市第一人民医院,湖南郴州423000

出　　处：《中国骨伤》2017年第9期828-832,共5页China Journal of Orthopaedics and Traumatology

摘　　要：目的:探讨微创通道辅助下治疗伴邻近节段退变腰椎滑脱症的治疗方法及临床疗效。方法:2014年4月至2016年1月,36例单节段腰椎滑脱症伴邻近节段退变患者接受微创通道下简化手术治疗(目标神经靶点减压、邻近节段椎间或椎板间小关节融合、单边内固定),其中退变性腰椎滑脱23例,峡部裂性腰椎滑脱13例,MeyerdingⅠ度16例,Ⅱ度17例,Ⅲ度3例。采用腰痛视觉模拟(VAS)评分、功能障碍指数(ODI)、JOA评分评估临床效果。结果:36例患者术中出血230~480 ml,平均340 ml;术后出血15~80 ml,平均43 ml;手术时间176~240 min,平均193 min;术中X线暴露时间2~6 s,平均3.6 s。2例术中硬膜囊撕裂,没有出现神经损伤表现。30例获得随访,时间12~17个月,平均15.2个月。术前、术后5 d及术后3个月随访时腰背痛VAS评分分别是7.6±1.7、1.9±0.4、0.8±0.4,术后5 d、术后3个月与术前比较差异有统计学意义(P<0.05)。术前及术后3个月ODI评分分别为35.9±1.2和3.7±0.7,差异有统计学意义(P<0.05)。术前、术后5 d及术后1、3个月JOA评分分别为13.2±0.4、24.4±0.4、27.4±0.1、27.9±0.5,术前与术后5 d及术后1、3个月比较差异有统计学意义。结论:微创通道下治疗伴邻近退变的腰椎滑脱症是一种安全有效,创伤小,操作简化,康复快的微创治疗方法。Objective ： To explore the method and clinical effect of MAST Quadrant for lumbar spondylolisthesis with ad- jacent segment degeneration. Methods：From April 2014 to January 2016,36 cases of lumbar spondylolisthesis with adjacent segment degeneration were treated by MAST Quadrant （target nerve decompression and transforaminal lumbar interbody fusion or artieulationes zygapophysiales fusion by unilateral fixation with MAST Quadrant）. Twenty-three cases were degenerative lumbar spondylolisthesis and 13 cases were isthmie lumbar spondylolisthesis. According to Meyerdiug grade of spondylolisthe- sis, 16 cases were grade I , 17 cases were grade II ,and 3 cases were grade III.Visual analogue score （VAS） ,Oswesty Dis- ability Index （ODI） and JOA score were used to evaluate the clinical outcome. Results：The amount of intraoperative bleeding was 230 to 480 ml with an average of 340 ml and the amount of postoperative blood loss was 15 to 80 ml with an average of 43 ml. Operative time was 176 to 240 min with an average of 193 rain;X-ray exposure time was 2 to 6 s with an average of 3.6 s. Two cases were complicated with dural tear without nerve injury during operation. Thirty cases were followed up from 12 to 17 months with an average of 15.2 months. VAS scores for preoperative, 5 days, 3 months after surgery were 7.6±1.7,1.9± 0.4,0.8±0.4 respectively, and there was significant difference before and after operation （P〈0.05）. The ODI scores for preoper- ative and 3 months after surgery were 35.9±1.2 and 3.7±0.7 respectively,and there was significant difference before and after operation （P〈0.05）. JOA scores for preoperative, 5 days, 1 months, 3 months after surgery were 13.2 ±0.4,24.4 ±0.4,27.4 ± 0.1,27.9±0.5 respectively, and there was significant difference before and after operation （P〈0.05）. Conclusion：MAST Quad- rant can be applied to treat lumbar spondylolisthesis with adjacent segment degeneration, and the minimally invasive sugical technique is a safe and effective method

关 键 词：腰椎滑脱症 邻近节段退变 外科手术 微创性 

分 类 号：R687.3[医药卫生—骨科学]