Quadrant通道下腰椎间盘切除单边动态固定术治疗腰椎间盘突出症的疗效观察

Curative effect observation of unilateral dynamic fixation under a Quadrant system combined with lumbar discectomy in the treatment of lumbar intervertebral disc herniation

中文关键词:  腰椎间盘突出症  Quadrant通道辅助技术  动态非融合固定系统

英文关键词:Lumbar disc herniation  Quadrant system technique  Dynamic non-fusion fixation system

中文摘要:

  【摘要】 目的：探讨Quadrant通道下腰椎间盘切除单边动态固定术治疗腰椎间盘突出症的临床效果。方法：回顾性分析2013年1月～2018年11月在我院行Quadrant通道下腰椎间盘切除单边动态固定术治疗的23例单节段腰椎间盘突出症患者，其中男13例，女10例；年龄20～40岁（31.0±6.9岁）。术后均获随访，随访时间28~68个月（42.0±6.6个月）。记录手术时间、术中出血量、术后住院时间等资料；于术前及术后2d、末次随访时采用视觉模拟（visualan alogue scale，VAS）评分、Oswestry功能障碍指数（Oswestry disability index，ODI）、日本骨科协会（Japanese Orthopaedic Association，JOA）评分评估手术的临床效果；于术后2d、末次随访时行腰椎正侧位及动力位X线片检查，测量椎间隙高度、椎间活动度；术前及末次随访时行腰椎MRI检查，应用Pfirrmann分级评估手术节段及邻近节段椎间盘高度及信号变化，计算Pfirrmann分级改善率。结果：所有患者均顺利完成手术，手术时间82.5±11.6min，术中出血量58.8±9.5ml，术后住院时间3.1±0.4d。患者术后2d、末次随访时的ODI、JOA评分及VAS评分均较术前有明显改善（P<0.05）。术后2d、末次随访时手术节段及其上位邻近节段椎间隙高度以及上位邻近节段活动度较术前无统计学差异（P＞0.05）；术后2d手术节段活动度较术前明显改善（P＜0.05）。末次随访时，手术节段Pfirrmann分级30.5%改善，56.5%无明显改变，13.0%退变加重；邻近节段8.7%改善，73.9%无明显改变，17.4%退变加重。随访期间无椎间盘突出复发，无螺钉松动、断裂、失效等相关并发症。结论：Quadrant通道辅助下腰椎间盘切除单边动态固定术治疗腰椎间盘突出症可获得良好的临床疗效，有效维持椎间隙高度，保留腰椎活动度。

英文摘要:

  【Abstract】 Objectives: To investigate the clinical effect of Quadrant system-assisted unilateral dynamic fixation combined with lumbar discectomy in the treatment of lumbar intervertebral disc herniation. Methods: 23 patients (13 males and 10 females) with lumbar disc herniation who underwent unilateral dynamic fixation combined with lumbar discectomy assisted with Quadrant system in our hospital from January 2013 to November 2018 were retrospectively analyzed. The patients averaged 31.0±6.9(20-40) years old and were followed up for 42.0±6.6 months(28-68 months). The operative time, intraoperative blood loss, and postoperative hospital stay were recorded. The visual analogue scale(VAS), Oswestry disability index(ODI), and Japanese Orthopaedic Association(JOA) score were compared between preoperation, 2d after operation, and final follow-up to assess the clinical outcomes. Anteroposterior lateral and dynamic lumbar X-rays examinations were performed on postoperative 2d and at final follow-up to measure the intervertebral space height and intervertebral motion range. Lumbar MRI examination was performed before and at final follow-up, and Pfirrmann scale was applied to evaluate the height and signal changes of the operative segments and adjacent segments, and Pfirrmann grading improvement was claculated. Results: All patients completed the operation successfully. The operation time was 82.5±11.6min, the intraoperative blood loss was 58.8±9.5ml, and postoperative hospital stay was 3.1±0.4d. The postoperative 2d and final follow-up ODI, JOA score, and VAS were significantly improved than before operation(P<0.05). The height of the intervertebral space of operative segments and upper adjacent segments and the range of motion of upper adjacent segments on postoperative 2d and at final follow-up were not statistically different from those before operation(P>0.05), while the range of motion of operative segments on postoperative 2d improved significantly than that before operation(P<0.05). At final follow-up, the Pfirrmann scale showed an overall improvement rate of 30.5% at the operative segments, 56.5% no significant change, and 13.0% degeneration aggravation; and 8.7% overall improvement at the adjacent segments, 73.9% no significant change, and 17.4% degeneration aggravation. During the follow-up, there was no recurrence of intervertebral disc herniation, screw loosening, fracture, failure or other related complications. Conclusions: The Quadrant system assisted unilateral dynamic fixation combined with lumbar discectomy can achieve good clinical effects in the treatment of lumbar disc herniation through effectively maintaining the height of the intervertebral space and preserving the range of motion of the lumbar spine.