Quadrant通道下经椎间孔微创置入椎体间融合器治疗腰椎退行性疾病  

Minimally invasive transforaminal lumbar interbody fusion through Quadrant channel for treatment of lumbar degenerative diseases

作　　者：黄群 盛晓磊 严飞[1] 周志平[1] 朱现玮 Huang Qun;Sheng Xiaolei;Yan Fei;Zhou Zhiping;Zhu Xianwei(Department of Orthopedics, Zhangjiagang First People’s Hospital, Soochow University, Suzhou 215600, Jiangsu Province, China)

机构地区：[1]苏州大学附属张家港医院骨科

出　　处：《中国组织工程研究》2019年第36期5818-5823,共6页Chinese Journal of Tissue Engineering Research

摘　　要：背景:传统的经椎间孔入路腰椎椎间融合治疗腰椎退行性疾病虽然疗效确切,但由于创伤大,会导致术中出血多、术后恢复慢等不良后果。随着脊柱外科微创技术不断发展,Quadrant通道下腰椎微创融合逐渐应用于腰椎退行性疾病的治疗。目的:比较Quadrant通道下腰椎微创融合与传统经椎间孔入路腰椎椎体间融合治疗腰椎退行性疾病的临床疗效。方法:纳入苏州大学附属张家港医院2015年1月至2016年7月收治的54例腰椎退行性疾病患者,根据治疗方案分为2组,腰椎微创融合组24例采用Quadrant通道下腰椎微创融合治疗,传统开放组30例采用传统经椎间孔入路腰椎椎体间融合治疗。所有患者对治疗方案均知情同意,且得到医院伦理委员会批准。对比2组患者的手术切口长度、手术时长、术中出血量、术后负压引流量,术前、术后3d及术后3,6,12个月记录目测类比疼痛评分(0分无痛,10分剧痛);术前及术后3,6,12个月评估Oswertry功能障碍指数。结果与结论:①54例患者均顺利完成手术;②腰椎微创融合组术中出血量、术后伤口引流量、切口长度均明显低于传统开放组(P<0.05),但手术时间较传统开放组长(P<0.05);③2组患者术前腰背疼痛目测类比评分和Oswertry功能障碍指数差异无显著性意义(P>0.05);术后3d及术后3个月腰椎微创融合组目测类比疼痛评分明显低于传统开放组(P<0.05);但术后6个月以及术后1年时2组腰背疼痛目测类比评分差异无显著性意义(P>0.05)。术后3个月时腰椎微创融合组Oswertry功能障碍指数明显低于传统开放组(P<0.05),但术后6个月、1年时2组患者Oswertry功能障碍指数差异无显著性意义(P>0.05);④术后摄片随访显示,2组患者治疗效果满意,手术节段融合良好;⑤结果提示Quadrant通道下腰椎微创融合是治疗腰椎退行性疾病的有效方式,与传统经椎间孔入路腰椎椎体间融合相比具有创伤小�BACKGROUND: Traditional transforaminal lumbar interbody fusion (TLIF) surgery for lumbar degenerative diseases is effective, but it will lead to adverse intraoperative hemorrhage and slow postoperative recovery because of severe trauma. With the continuous development of minimally invasive techniques in spinal surgery, minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) through the Quadrant channel is gradually applied in the treatment of lumbar degenerative diseases. OBJECTIVE: To compare the clinical efficacy of MIS-TLIF versus traditional TLIF in the treatment of lumbar degenerative diseases. METHODS: A total of 54 patients with the lumbar degenerative diseases who received treatment from January 2015 to July 2016 in Zhangjiagang First People’s Hospital, Soochow University were retrospectively analyzed. These patients were randomly assigned to receive MIS-TLIF through the Quadrant channel (n=24) or traditional TLIF (n=30). All patients provided written informed consent and the study was approved by Medical Ethics Committee of Zhangjiagang First People’s Hospital. The length of surgical incision, operation time, intraoperative blood loss, and postoperative drainage volume were compared between these two groups. In addition, prior to surgery, and 3 days, 3, 6, 12 months after surgery, Visual Analogue Scale score with 0 indicating no pain and 10 representing most severe pain was recorded. Oswestry disability index was recorded prior to surgery and 3, 6, and 12 months after surgery. RESULTS AND CONCLUSION:(1) All 54 patients successfully completed the surgery.(2) Intraoperative blood loss, length of incision, postoperative drainage volume were significantly lower in the MIS-TLIF group than in the traditional TLIF group (P < 0.05);but the operation time was longer (P < 0.05).(3) There were no significant differences in Visual Analogue Scale score and Oswestry disability index pre-surgery between MIS-TLIF and traditional TLIF groups (P > 0.05). At 3 days and 3 months after surgery, Visual Analog

关 键 词：骨生物材料 腰椎退行性疾病 QUADRANT通道 微创 腰椎椎体间融合 

分 类 号：R459.9[医药卫生—治疗学] R318[医药卫生—临床医学]