双侧肌间隙入路Quadrant系统下行腰椎翻修术

Bilateral paramedian approach under quadrant system for lumbar revision surgery

中文关键词:  微创  Quadrant系统  微创经椎间孔腰椎椎体间融合术  翻修  腰椎

英文关键词:Minimal invasive  Quadrant system  TLIF  Revison  Lumbar

中文摘要:

  【摘要】 目的：探讨后正中皮肤切口椎旁双侧肌间隙入路微创经椎间孔腰椎椎体间融合（TLIF）技术在腰椎翻修手术中的临床疗效。方法：2007年3月～2010年2月我院收治的手术后行腰椎翻修患者24例，其中腰椎间盘突出症行腰椎间盘镜下髓核摘除术后8例、腰椎间盘突出症行单纯椎板开窗减压髓核摘除术后10例、腰椎管狭窄症后路椎板开窗减压术后6例。其中L4/5 13例、L5/S1 11例。均采用后正中皮肤切口椎旁双侧肌间隙入路，在Quadrant可扩张管道系统下行微创TLIF手术。采用JOA（29分法）功能评分对患者再次手术前、手术后1年临床疗效进行评估、并计算改善率。结果：随访时间14～26个月，平均16个月。患者均无脑脊液漏、无神经根损伤。术前JOA评分为13.91±1.44分，术后1年JOA评分为23.70±1.33分，与术前比较有统计学差异（P﹤0.05）。根据改善率评估临床效果，其中优17例、良5例、可2例。结论：后正中切口双侧肌间隙入路在Quadrant可扩张管道系统下行微创TLIF是腰椎翻修的一种可行方法。

英文摘要:

  【Abstract】 Objective：To investigate the clinical outcome of minimal invasive transforaminal lumbar interbody fusion（TLIF） via bilateral paramedian approach for lumbar revision surgery.Method：From March 2007 to February 2010，the clinical data of 24 patients suffering from failed primary lumbar surgery（8 discectomics due to LDH under MED，10 discectomics due to LDH under window of laminar，6 windows of laminas due to lumbar spinal stenosis） were reviewed retrospectively.A total of 24 segments were involved，including L4/5 in 13cases，L5/S1 in 11 cases.All 24 cases suffering from failed back surgery syndrome underwent minimal invasive TLIF via bilateral paramedian approach under MAST Quadrant system.JOA（29） score system was used to evaluate the pre-and post-revision operative（12 months） outcome as well as the improvement rate.Result：All patients were followed up for 14～26 months（mean，16 months）.No cerebrospinal fluid leakage and nerve root injury were noted.The mean JOA score for preoperation and 12 months after operation was 13.91±1.44 and 23.70±1.33 respectively，which showed statistical significance（P<0.05）.Based on the improvement rate，there were 17 excellent，5 good and 2 fair.Conclusion：Minimal invasive transforaminal lumbar interbody fusion via bilateral paramedian approach under quadrant system is reliable and effective for lumbar revision surgery.