Quadrant通道下经椎间孔单侧入路双侧减压植骨融合内固定术治疗腰椎间盘突出症43例  

Bilateral decompression and fusion with internal fixation via unilateral transforaminal approach under Quadrant system for lumbar disc herniation

作　　者：邢帅 鹿文博 李志斌 郑谊[2] 安占天[2] 张锴 高延征 王红强 施新革 XING Shuai;LU Wenbo;LI Zhibin;ZHENG Yi;AN Zhantian;ZHANG Kai;GAO Yanzheng;WANG Hongqiang;SHI Xinge(Department of Spine and Spinal Cord Surgery,Henan Provincial People's Hospital(People's Hospital of Zhengzhou University),Zhengzhou 450003;Department of Spinal Orthopedics,Hongxing Hospital of the 13th Division of Xinjiang Production and Construction Corps,Hami,Xinjiang 839000)

机构地区：[1]河南省人民医院(郑州大学人民医院)脊柱脊髓外科,郑州450003 [2]新疆生产建设兵团第十三师红星医院脊柱骨科,新疆哈密839000

出　　处：《郑州大学学报(医学版)》2025年第2期229-233,共5页Journal of Zhengzhou University(Medical Sciences)

基　　金：河南省医学科技攻关项目(LHGJ20220034);河南省医学科技攻关计划项目(SB201901085)。

摘　　要：目的:探讨Quadrant通道下经椎间孔单侧入路双侧减压植骨融合内固定术治疗腰椎间盘突出症的临床效果。方法:回顾性收集2014年7月至2021年1月河南省人民医院收治的腰椎间盘突出症患者43例,均采用Quadrant通道下经椎间孔单侧入路双侧减压植骨融合内固定术治疗。术前、术后3个月、末次随访采用视觉模拟评分(VAS评分)、腰椎JOA评分、改良Oswestry功能障碍指数(ODI)及Pfirrmann分级评估疗效,采用腰椎正侧位及动力位片和(或)CT评价邻椎活动度及椎间融合情况。记录术中及术后并发症发生情况。结果:随访(47.3±9.1)个月。术前、术后3个月、末次随访时,VAS评分逐步降低(7.3±0.9、3.8±0.7、0.7±0.6),JOA评分逐步升高(9.6±1.3、22.6±2.3、26.9±8.1),ODI逐步降低(66.4±4.7、22.3±1.4、9.8±1.0)(P<0.05);末次随访时,邻近节段椎间盘退变Pfirrmann分级与术前比较差异无统计学意义(P>0.05)。邻近节段椎间隙高度、邻椎活动度差异均无统计学意义(P>0.05)。随访期间未发生内固定松动、邻椎病等并发症。结论:Quadrant通道下经椎间孔单侧入路双侧减压植骨融合内固定术治疗腰椎间盘突出症临床疗效确切,对椎旁结构破坏小,可有效维持椎体序列稳定。Aim:To investigate the clinical effect of bilateral decompression and fusion with internal fixation via unilateral transforaminal approach under Quadrant system for lumbar disc herniation.Methods:Clinical data of 43 patients with lumbar disc herniation admitted in Henan Provincial People′s Hospital from July 2014 to January 2021 were retrospectively analyzed.All the patients were treated with bilateral decompression and fusion with internal fixation via unilateral transforaminal approach under Quadrant system.The clinical outcomes were evaluated using the visual analogue scale(VAS),Japanese orthopaedic association(JOA)score for the lumbar spine,the modified Oswestry disability index(ODI),and the Pfirrmann grading system before surgery,3 months after surgery,and at the last follow-up.Lumbar anterolateral and dynamic radiographs and/or CT scans were used to evaluate the range of motion of the adjacent vertebra and interbody fusion,and the incidence of intraoperative and postoperative complications were recorded.Results:The follow-up time was(47.3±9.1)months.Before surgery,3 months after surgery,and at the last follow-up,the VAS score gradually decreased(7.3±0.9,3.8±0.7,0.7±0.6),the JOA score gradually increased(9.6±1.3,22.6±2.3,26.9±8.1),and the ODI gradually decreased(66.4±4.7,22.3±1.4,9.8±1.0)(P<0.05).At the last follow-up,there was no significant difference in the Pfirrmann grade of adjacent segment intervertebral disc degeneration compared with that before surgery(P>0.05).There was no significant difference in the height of the intervertebral space or intervertebral mobility of the adjacent segments(P>0.05).During the follow-up,there were no complications such as loosening of internal fixation and adjacent vertebral disease.Conclusion:The treatment of lumbar disc herniation by unilateral approach of Quadrant system through foraminal with bilateral decompression and internal fixation has exact clinical efficacy,minimal paravertebral soft tissue destruction and effective maintenance of vertebral body

关 键 词：腰椎间盘突出症 微创手术 Quadrant通道辅助技术 单侧入路双侧减压 

分 类 号：R681.53[医药卫生—骨科学]