经Wiltse入路Quadrant通道下椎间盘切除术并纤维环修复术治疗单节段腰椎椎间盘突出症  

Wiltse approach discectomy under Quadrant channel and annulus fibrosus repair for treatment of single-segment lumbar disc herniation

作　　者：姚东元 郑杰[1] 陈源[1] 陆禹严[1] Yao Dongyuan;Zheng Jie;Chen Yuan;Lu Yuyan(Department of Orthopaedics,Yulin First People’s Hospital,Yulin 5370009 Guangxi Zhuang Autonomous Region,China)

机构地区：[1]玉林市第一人民医院骨科,玉林537000

出　　处：《脊柱外科杂志》2022年第1期16-21,共6页Journal of Spinal Surgery

基　　金：吴阶平医学基金会临床科研专项资助基金课题(320-2745-16-61)。

摘　　要：目的探讨经Wiltse入路Quadrant通道下椎间盘切除术并纤维环修复术治疗单节段腰椎椎间盘突出症(LDH)的临床疗效。方法2016年1月—2018年9月收治单节段LDH患者82例,其中采用经Wiltse入路Quadrant通道下椎间盘切除术治疗47例(对照组),采用经Wiltse入路Quadrant通道下椎间盘切除术并纤维环修复术治疗35例(修复组)。记录2组手术时间、术中出血量,术前及术后各随访时间点腰痛和腿痛视觉模拟量表(VAS)评分、Oswestry功能障碍指数(ODI)及手术节段椎间隙高度。记录术前及末次随访时病变节段椎间盘Pfirrmann分级。观察2组术后复发情况及再手术情况,记录复发时间。结果所有手术顺利完成。所有患者随访超过24个月。2组手术时间及术中出血量差异无统计学意义(P>0.05)。2组术后各时间点腰痛VAS评分、腿痛VAS评分及ODI较术前显著改善,差异有统计学意义(P<0.05);组间差异无统计学意义(P>0.05)。末次随访时,对照组手术节段椎间隙高度较术前降低14.66%,修复组较术前降低12.54%,组间差异无统计学意义(P>0.05)。末次随访时2组均未出现椎间盘退行性变程度加重的现象。对照组术后同节段复发4例,复发率为8.51%,平均复发时间为术后12.6个月;再手术患者3例,再手术率为6.38%,平均再次手术时间为术后14.2个月。修复组术后无复发病例,无再手术病例。结论经Wiltse入路Quadrant通道下椎间盘切除术并纤维环修复术治疗单节段LDH安全、有效,在严格遵循适应证及规范操作的基础上,可有效降低术后复发及再次手术的风险。Objective To investigate the clinical efficacy of Wiltse approach discectomy under Quadrant channel and annulus fibrosus repair for the treatment of single-segment lumbar disc herniation(LDH).Methods From January 2016 to September 2018,82 patients with single-segment LDH were treated,including 47 cases treated with Wiltse approach discectomy under Quadrant channel(control group)and 35 with Wiltse approach discectomy under Quadrant channel and annulus fibrosus repair(repair group).The operation time,intraoperative blood loss,visual analogue scale(VAS)score of low back and leg pain,Oswestry disability index(ODI)and the intervertebral space height of the operation segment before and after operation were recorded.Pfirrmann grade were recorded before operation and at the final follow-up.The recurrence and reoperation conditions of the 2 groups were observed,and the recurrence time was recorded.Results All the operations were successfully completed.All the patients were followed up for more than 24 months.There was no significant difference in operation time and intraoperative blood loss between the 2 groups(P>0.05).The VAS score of low back and leg pain and ODI of the 2 groups at each time point after operation were significantly improved compared with those before operation,all with a statistical significance(P<0.05);and there was no significant difference between the 2 groups at each time point(P>0.05).At the final follow-up,the intervertebral space height of the operation segment in the control group was reduced by 14.66%,and repair group reduced by 12.54%,and there was no significant difference between the 2 groups(P>0.05).At the final follow-up,there was no aggravation of intervertebral disc degeneration in both groups.In the control group,4 patients recurred in the same segment,and the recurrence rate was 8.51%,and the mean recurrence time was 12.6 months;3 patients underwent reoperation,and the reoperation rate was 6.38%,and the mean reoperation time was 14.2 months.There was no recurrence and reoperation case

关 键 词：腰椎 椎间盘移位 椎间盘切除术 外科手术 微创性 

分 类 号：R681.553.1[医药卫生—骨科学]