Quadrant通道下经椎间孔腰椎椎体间融合术治疗复发性腰椎间盘突出症的疗效

The clinical outcome of minimally invasive transforaminal lumbar interbody fusion under Quadrant system for recurent lumbar disc herniation

中文关键词:  腰椎间盘突出症  复发性  经椎间孔腰椎椎体间融合术  Quadrant通道  疗效

英文关键词:Recurrent lumbar disc herniation  Transforaminal lumbar interbody fusion  Quadrant system  Effect

中文摘要:

  【摘要】 目的：探讨Quadrant通道下微创经椎间孔腰椎椎体间融合术（TLIF）治疗复发性腰椎间盘突出症的临床疗效。方法：2007年2月～2010年3月采用微创TLIF治疗复发性腰椎间盘突出症患者35例，男22例，女13例；年龄33～62岁，平均53.2岁；L4/5 18例，L5/S1 13例，L4/5和L5/S1双节段4例。复发时间为初次手术后8～70个月，平均38.2个月。均经椎旁肌间隙在Quadrant可扩张管道系统下行微创TLIF。采用视觉模拟评分（VAS）评估患者术前、术后3d和术后1年的疼痛情况；采用腰椎JOA功能评分（29分法）对患者术前、术后1年的腰椎功能进行评估，并计算改善率，按改善率判定临床疗效。结果：手术时间为105～210min，平均145min；术中出血量210～580ml，平均335ml；术后引流量90～230ml，平均140ml。术中均无脑脊液漏及神经根损伤。术前VAS评分为7.63±0.81分，术后3d为2.46±0.92分，术后1年为1.14±0.69分，术后3d与术前比较、术后1年与术后3d比较均有统计学差异（P﹤0.05）。术前JOA评分为14.26±1.36分，术后1年为25.06±1.19分，术后1年与术前比较有统计学差异（P<0.05）；术后1年时JOA评分改善率为41%～90%，平均78%，优21例，良10例，可4例。随访19～41个月，平均20个月，植骨均融合，融合时间为6～12个月，平均9.5个月，随访期间无椎弓根螺钉断裂、融合器移位。结论：经Quadrant通道微创TLIF治疗复发性腰椎间盘突出症临床疗效满意。

英文摘要:

  【Abstract】 Objectives: To investigate the clinical outcomes of minimally invasive transforaminal lumbar interbody fusion(TLIF) under Quadrant system for recurrent lumbar disc herniation. Methods: From February 2007 to March 2010, a total of 35 cases suffering from recurrent lumbar disc herniation and undergoing surgical intervention was retrospectively analyzed. There were 22 males and 13 females, with a mean age of 53.2 years(range, 33-62 years). A total of 39 segments was involved, including L4/5 in 18 cases, L5/S1 in 13 cases, L4/5 and L5/S1 in 4 cases. The interval between first operation and recurrence was 8-70 months(mean, 38.2 months). 35 cases underwent bilateral minimally invasive TLIF under Quadrant system. VAS score system was used to evaluate back pain at pre- and post- operation(3d and 12 months). JOA(29) score system was used to evaluate the pre- and post- operative(12 months) score and improvement rate, which was used to evaluate clinical effects. Results: The operation time was 105-210min(mean, 145min), blood loss was 210-580ml(mean, 335ml), drainage was 90-230ml(mean, 140ml). No leakage of cerebrospinal fluid or nerve root injury was noted during the operation. VAS score was 7.63±0.81 at preoperation, 2.46±0.92 at 3d postoperation, 1.14±0.69 at 12 months postoperation, which showed statistical significance between preoperative and 3d postoperation(P<0.05) as well as between 3d postoperation and 12 months postoperation(P<0.05). The mean score of JOA was 14.26±1.36 at preoperation, 25.06±1.19 at 12 months postoperation, which showed statistical significance between preoperation and 12 months postoperation(P<0.05). The improvement rate was 41%-90%(mean, 78%) at 12 months postoperation. According to the rate of clinical improvement, there were 21 excellent, 10 good and 4 fair. All patients were followed up for 19-41 months(mean, 20 months), and all cases got bony fusion with the fusion time of 6-12 months(mean, 9.5 months). No instrument failure was noted. Conclusions: Minimally invasive TLIF under Quadrant system can achieve reliable clinical results for recurrent lumbar disc herniation.