文章摘要
石义华,周轶,晏雄伟,等.双切口Quadrant通道下微创经椎间孔椎间融合术治疗退行性腰椎疾病.骨科,2017,8(2): 99-102.
双切口Quadrant通道下微创经椎间孔椎间融合术治疗退行性腰椎疾病
Clinical observation of TLIF in double-incision under Quadrant channel in treatment of lumbar degenerative disease
投稿时间:2016-09-14  
DOI:10.3969/j.issn.1674-8573.2017.02.005
中文关键词: 腰椎  脊柱融合术  外科手术,微创  腰椎退行性变  Quadrant通道  椎弓根螺钉
英文关键词: Lumbar vertebrae  Spinal fusion  Surgical procedures, minimally invasive  Lumbar degenerative disease  Quadrant channel  Pedicle screw
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作者单位E-mail
石义华 441021 湖北襄阳湖北文理学院附属襄阳市中心医院骨一科  
周轶 441021 湖北襄阳湖北文理学院附属襄阳市中心医院骨一科  
晏雄伟 441021 湖北襄阳湖北文理学院附属襄阳市中心医院骨一科 415607947@qq.com 
廉凯 441021 湖北襄阳湖北文理学院附属襄阳市中心医院骨一科  
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中文摘要:
      目的 探讨腰椎双侧小切口下普通椎弓根螺钉结合Quadrant通道下,改进微创经椎间孔椎间融合术(minimally invasive transforaminal lumbar interbody fusion, MIS-TLIF)治疗退行性腰椎疾病的临床疗效。方法 回顾性分析2014年10月至2015年10月我科收治的55例退行性腰椎疾病病人,男19例,女36例;年龄为46~78岁,平均为(62.3±2.5)岁。术前常规完善腰椎正侧位及过伸过屈位X线、CT及MRI检查,影像学诊断:腰椎间盘突出症突出并不稳30例(其中6例为单纯髓核摘除术后复发),腰椎管狭窄17例,腰椎滑脱8例。病人均采用双切口Quadrant通道下改进MIS-TLIF手术治疗,双侧减压20例,单侧减压35例。通过比较术前及术后末次随访的疼痛视觉模拟量表(visual analogue scale, VAS)评分、日本骨科学会(Japanese Orthopaedic Association, JOA)腰椎评分法评定腰椎疼痛和功能改善状况,按改良MacNab临床评估标准评定术后疗效。结果 手术切口均一期愈合。55例病人均获得随访,随访时间为12~36个月,平均为(24.2±2.2)个月。末次随访时,VAS评分由术前的(7.4±2.1)分降至(2.1±1.2)分,JOA评分由术前的(8.4±1.5)分升高至(24.5±2.3)分,术后与术前比较,差异均有统计学意义(均P<0.05)。末次随访时按改良MacNab标准评价疗效:优47例,良8例。随访期间病人均无复发。结论 双切口Quadrant通道下TLIF治疗腰椎退行性病变疗效显著,术后复发率低。
英文摘要:
      Objective To evaluate the clinical curative effect of minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) under Quadrant channel combined with common pedicle screw with double small incision in the treatment of lumbar degenerative disease. Methods The clinical data of 55 patients with lumbar degenerative disease from October 2014 to October 2015 were retrospectively analyzed. There were 19 males and 36 females with average age of (62.3±2.5) years old (range, 46-78 years old). Before the operation, MRI, CT and X-ray examinations were performed. Imaging diagnosis showed 30 cases of lumbar disc herniation and instability (including 6 cases of simple discectomy recurrence), 17 cases of lumbar canal stenosis, and 8 cases of lumbar spondylolisthesis. All patients were treated with TLIF in double-incision under Quadrant channel: 20 cases given bilateral decompression, and 35 cases given unilateral decompression. The VAS score and JOA score were compared between preoperation and postoperative last follow-up, and the improvement of lumbar pain and function was assessed. The modified MacNab criteria were used to evaluate the curative effect after operation. Results All cases were followed up for 12-36 months [average of (24.2±2.2) months]. At the end of the follow-up, low back pain VAS score was reduced from preoperative 7.4±2.1 to 2.1±1.2, and JOA score was increased from operative (8.4±1.5) to (24.5±2.3) points, at the last follow-up after operation. The difference was statistically significant (P<0.05). At last follow-up, the efficacy was evaluated according to the modified MacNab criteria, and the results were excellent in 47 cases and good in 8 cases. No case recurred during the follow-up period. Conclusion TLIF in double-incision under Quadrant channel in the treatment of lumbar degenerative disease has obvious curative effect. The recurrent rate is low.
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