微创通道经椎间孔减压融合结合椎弓根螺钉固定治疗腰椎病变  

Minimally invasive transforaminal lumbar interbody fusion with Quadrant channel combined with percutaneous pedicle screw for treatment of lumbar disease

作　　者：赵星毅 沙卫平[1] 黄群 宋锦程[1] 王黎明[1] 严飞[1] ZHAO Xing-yi;SHA Wei-ping;HUANG Qun;SONG Jin-cheng;WANG Li-ming;YAN Fei(Dept of Spine Surgery,Zhangjiagang Hospital Affiliated of Soochow University,Zhangjiagang,Jiangsu 215600,China)

机构地区：[1]苏州大学附属张家港医院脊柱外科,江苏张家港215600

出　　处：《临床骨科杂志》2022年第1期35-39,共5页Journal of Clinical Orthopaedics

基　　金：江苏省卫生厅重点学科建设开放课题(编号:WKF2013-02);江苏省科技厅科技支撑计划(社会发展)项目(编号:BE2011605);江苏省张家港市卫健委青年科技项目(编号:ZJGQNKJ202004)。

摘　　要：目的探讨微创通道经椎间孔减压融合结合椎弓根螺钉固定治疗腰椎病变的疗效。方法将50例腰椎病变患者按照手术方案不同分为A组(采用微创通道经椎间孔减压融合结合椎弓根螺钉固定,23例)和B组(采用改良后路减压椎体间融合固定,27例)。比较两组手术时间、术中出血量、术后住院时间、疼痛VAS评分、ODI评分,并根据术后12个月JOA评分计算评分改善率。结果患者均获得随访,A组随访时间12~17个月,B组随访时间12~20个月。两组术后均未发生明显并发症及不良反应。术中出血量、术后住院时间A组明显少于B组(P<0.01),但手术时间A组明显长于B组(P<0.01);术后3、12个月腰痛VAS评分和术后3个月ODI评分A组均明显低于B组(P<0.05);术后12个月JOA评分改善率两组比较差异无统计学意义(P>0.05)。术后12个月两组内固定位置均良好,融合器未见塌陷,手术节段椎间骨性融合。结论微创通道经椎间孔减压融合结合椎弓根螺钉固定治疗腰椎病变疗效确切,具有创伤小、术中出血量小、住院时间短、患者恢复快等优点,但需严格把握适应证。Objective To investigate the clinical efficacy of minimally invasive transforaminal lumbar interbody fusion(MIS-TILIF)via Quadrant channel combined with percutaneous pedicle screw internal fixation in the treatment of lumbar diseases.Methods A total of 50 patients with lumbar disease were divided into group A(23 patients were treated with MIS-TILIF with Quadrant channel combined with percutaneous screw internal fixation.)and group B(27 patients were treated with modified posterior decompression intervetebral fusion and internal fixation),according to different surgical plan.The operative time,intraoperative blood loss volume,postoperative hospital stay,pain VAS and ODI score were compared,and the postoperative score improvement rate was calculated according to the JOA score at 12 months after surgery.Results All patients were recieved follow-up,and the time of group A was 12~17 months,group B was followed up for 12~20 months.There were no obvious complications and adverse reaction in two groups.The volume of intraoperative blood loss and postoperative hospitalization time of group A were significantly lower than those of group B(P<0.01),but the operative time of group A was significantly longer than that of group B(P<0.01).Both VAS of backache at postoperative 3,12 months and ODI score at 3 months postoperation in group A were significantly lower than those in group B(P<0.05).At 12 months after surgery,there was no significant difference in the improvement rate of JOA score between the two groups(P>0.05).At 12 months after the operation,the internal fixation position in both groups were good,and no collapse of the fusion cage was found,and the surgical segmental bony fusion was obtained.Conclusions MIS-TLIF with Quadrant channel combined with percutaneous pedicle screw internal fixation in the treatment of lumbar diseases has definite efficacy,with the advantages of less trauma,less intraoperative blood loss,short hospital stay,and fast recovery of patients,but the indications should be strictly controlled.

关 键 词：腰椎病变 微创 椎体间融合 QUADRANT通道 经皮椎弓根螺钉 

分 类 号：R681.5[医药卫生—骨科学] R687.3[医药卫生—外科学]