Wiltse入路单侧MIS-TLIF联合对侧经皮内固定术治疗极外侧型腰椎间盘突出症的疗效分析  

The curative effect of Wiltse approach and transforaminal lumbar interbody fusion via Quadrant with contralateral percutaneous pedicle screw fixation for the treatment of far lateral lumbar disc herniation

作　　者：孙志波 郭骏 陈荣 郭潇 李相伟 肖亮 赵林 陈驰 禹志宏 Sun Zhibo;Guo Jun;Chen Rong;Guo Xiao;Li Xiangwei;Xiao Liang;Zhao Lin;Chen Chi;Yu Zhihong(Department of Traumatic Orthopaedics,Remnin Hospital,Hubei University of Medicine,Shiyan Hubei442000,China)

机构地区：[1]湖北医药学院附属人民医院创伤骨科,湖北十堰442000

出　　处：《生物骨科材料与临床研究》2017年第6期14-17,21,共5页Orthopaedic Biomechanics Materials and Clinical Study

摘　　要：目的探讨并分析Quadrant通道下经Wiltse入路单侧MIS-TLIF(Minimally Invasive transforminal lumbar interbody fusion)联合对侧Sextant经皮钉棒系统内固定术(percutaneous pedicle screw fixation,PPSF)治疗单节段极外侧型腰椎间盘突出症(far lateral lumbar disc herniation,FLLDH)的中期临床疗效。方法 2012年5月至2015年5月共治疗极外侧型腰椎间盘突出症病例30例,均采用Quadrant通道下经Wiltse入路单侧MIS-TLIF联合对侧Sextant经皮钉棒系统内固定术。记录手术时间、术中出血量及X线暴露次数,疼痛视觉模拟评分VAS、腰椎JOA功能评分;按改良Macnab标准评价优良率;根据Bridwell法评估椎间植骨融合情况。结果 30人获随访,时间12~26个月。平均手术时间110 min;平均术中出血量155 mL;平均X线暴露次数26.6次。末次随访时VAS及JOA评分,与术前相比差异有统计学意义(<0.05)。末次随访时根据改良Macnab标准优良率为96.7%。按Bridwell椎间融合标准本组融合率为100%,平均椎间融合时间为8.6个月。结论微创Quadrant通道下经Wiltse入路单侧MIS-TLIF联合对侧Sextant经皮钉棒系统内固定术治疗单节段极外侧型腰椎间盘突出症中期临床疗效满意,具有手术创伤小、出血少、恢复快,能有效维持术后脊柱稳定性等优点,其远期效果有待进一步研究。Objective To investigate the mid-term clinical efficacy of Wiltse approach and transforaminal lumbar interbody fusion via Quadrant with contralateral percutaneous pedicle screw fixation for the treatment of far lateral lumbar disc herniation.Methods Thirty selective patients with single level FLLDH who underwent Wiltse approach and transforaminal lumbar interbody fusion via Quadrant with contralateral percutaneous pedicle screw fixation from May2012to May2015were retrospectived investigated.The follow-up evaluation included operative time,blood loss,X-Ray,VAS score and JOA score.Subjective satisfaction with the result of surgery was classified as excellent,good,fair,and poor based on MacNab criteria.Bridwell method was used to evaluate the lumbar interbody fusion.Results All patients were followed up for12to26months.Median operation time was140min,estimated blood loss during the procedure was added up to a mean of155mL,median operation X-ray exposure time was26.6times.VAS and JOA score were showed statistical significance between preoperation and final follow-up(P<0.05).According to reforming Macnab standard,the results were excellent in25cases and good in4cases at the last follow-up.All cases got bony fusion with the mean fusion time of8.6months.Conclusion The Wiltse approach and transforaminal lumbar interbody fusion via Quadrant with contralateral percutaneous pedicle screw fixation turn out to be safe and effective alternative procedure for the treatment of far lateral lumbar disc herniation,but the long-term effect still need study.

关 键 词：极外侧型腰椎间盘突出 Mast QUADRANT系统 Wiltse入路 MI-TLIF 经皮椎弓根螺钉内固定术 微创手术 

分 类 号：R687.3[医药卫生—骨科学]