经皮椎弓根螺钉内固定联合Quadrant微创撑开系统在治疗腰椎退行性疾病中的临床应用

Percutaneous pedicle screws combined with Quadrant system for lumbar degenerative disease

中文关键词:  Quadrant  微创撑开系统  腰椎间盘突出症  经皮椎弓根钉

英文关键词:Quadrant system  Lumbar disk herniation  Percutaneous pedicle screw fixation

中文摘要:

  【摘要】 目的：探讨经皮椎弓根螺钉内固定联合Quadrant微创撑开系统在治疗腰椎退行性疾病中的临床应用价值。方法：我院于2010年2月～2012年2月共治疗腰椎退行性疾病患者92例，随机对其中46例采用经皮椎弓根内固定联合Quadrant微创撑开系统行椎间盘摘除植骨融合术治疗（微创组），46例采用传统后路腰椎间融合术（PLIF）治疗（传统组），分别对两组手术时间、切口长度、失血量、末次随访时根据改良MacNab标准判定的优良率、术前及术后半年与术后1年腰背痛VAS评分、并发症等进行对比分析。结果：患者均获随访，随访时间4~24个月，平均16个月。微创组术后并发症出现切口延期愈合1例，脑脊液漏1例。微创组与传统组的手术时间分别为100.0±21.7min和91.0±18.1min，优良率分别为89.2％和86.9％，两组间比较差异无显著性（P＞0.05）。微创组与传统组术前VAS评分分别为6.0±3.3分和6.3±2.5分，术后6个月时分别为2.5±1.3分和2.6±1.4分，术后1年时分别为1.4±1.1分和1.3±1.1分，两组患者术后腰背痛较术前均得到缓解（P＜0.05），两组间比较差异无显著性（P＞0.05）。手术切口微创组（2.5±0.2cm）小于传统组（5.1±0.6cm），出血量微创组（80.0±7.2ml）少于传统组（152.0±12.3ml），差异均有显著性（P＜0.05）。微创组24例在术后3个月，18例在术后6个月，其余4例患者在术后1年时影像学上获得植骨融合；传统组25例在术后3个月，18例在术后6个月，其余3例患者在术后1年时影像学上获得植骨融合。结论：经皮椎弓根内固定联合Quadrant微创撑开系统应用于腰椎后路治疗腰椎间盘突出症是一种安全、有效的方法，较之传统后路手术具有切口小，出血量少的优势。

英文摘要:

  【Abstract】 Objectives: To evaluate the clinical application of percutaneous pedicle screws combined with Quadrant system for lumbar degenerative disease. Methods: 92 patients with lumbar disc herniation were treated in our hospital from Feburary 2010 to Feburary 2012. They were divided into two groups randomly, 46 patients underwent percutaneous pedicle screws combined with Quadrant system (MIS group), the others experienced posterior lumbar interbody fusion(PLIF)(conventional group). The operation time, length of incision, blood loss, excellent to good rate at final follow-up were evaluated by modified MacNab criteria, and the VAS score of low back pain and complications before operation, 6 months and 1 year after operation between two groups were recorded and compared. Results: All patients were followed up for 4-24 months(average, 16 months). In the MIS group, 1 cases suffered from delayed incision healing, and 1 case suffered from CSF leak. The operation time of MIS group and conventional group was 100.0±21.7min and 91.0±18.1min, and the excellent-to-good rate was 89.2％ and 86.9％ respectively, which showed no significant difference(P＞0.05). Preoperative VAS score for low back pain of 2 groups was 6.0±3.3 and 6.3±2.5 respectively, 2.5±1.3 and 2.6±1.4 at 6 months and 1.4±1.1 and 1.3±1.1 at 1 year after operation respectively, which improved significantly compared with the preoperatives(P＜0.05). Compared with the conventional group, the MIS group had shorter length of incision and less blood loss(P＜0.05). In the MIS group, 24 cases obtained bony fusion at 3 month follow-up, 18 cases obtained bony fusion at 6 month follow-up, 4 cases obtained bony fusion at 1 year follow-up. While in the conventional group, it was 25, 18 and 3 cases obtained bony fusion at corresponding follow-ups respectively. Conclusions: Percutaneous pedicle screws combined with Quadrant system is safe and effective for lumbar degenerative disease, which has less skin incision and blood loss compared with conventional treatment.