微创入路单侧椎弓根钉联合关节突螺钉内固定治疗下腰椎退行性疾病

目的探讨多裂肌间隙入路可扩张管微创系统（Quadrant系统）辅助下单侧椎弓根钉联合对侧椎板关节突螺钉内固定cage椎间植骨融合术治疗下腰椎退行性疾病的疗效。方法2010年1月～2011年12月对40例单节段下腰椎退行性疾病采用多裂肌间隙人路，经椎间孔融合器植骨单侧椎弓根螺钉固定，并在椎间盘镜通道辅助直视下行对侧椎板关节突螺钉内固定。根据视觉疼痛模拟评分（visual analogue scores，VAS）及Nakai标准评定临床疗效。结果切口长3．0～4．0cm，平均3．3cm。手术时间70～120min，平均85min。术中出血量90～400ml，平均150ml。术后切口无感染、皮肤坏死。40例随访12～24个月，平均18．2月。术后1年随访时患者腰痛VAS评分从术前（6．8±2．6）分降至（2．7±1．3）分，腿痛VAS评分从术前（8．1±2．4）分降至（2．9±1．4）分。疗效评定采用Nakai标准：优25例，良12例，可3例，优良率92．5％（37／40）。所有患者无螺钉松动、断裂及cage移位等并发症。结论Quadrant系统下多裂肌间隙人路单侧椎弓根钉联合对侧椎板关节突螺钉内固定具有操作简单、出血少、稳定可靠、并发症少、疗效确切等优点．是部分下腰椎病变固定融合的理想方法。

Therapeutic Effects of Unilateral Pedicle Screw Combined with Contralateral Translaminar Facet Screw Fixation Using Transmultifidus Approach and lnterbody Fusion in the Treatment of Lower Lumbar Degenerative Diseases

Objective To investigate the efficacy of unilateral pedicle screw combined with contralateral translaminar facet screw through transmutifidus approach under Mast Quadrant for lower lumbar degenerative disease. Methods From January 2010 to December 2011,40 patients with single-level lumbar disc disease were treated with minimally invasive transforaminal lumbar interbody fusion and unilateral pediele screw combined with eontralatera translaminar facet screw fixation through transmutifidus approach under Mast Quadrant. Visual analogue scores（VAS） and Nakai criteria were used for clinical assessment. Results The average length of skin incision was 3.3 cm （range,3.0 -4.0 cm） ,the average operative time was 85 min （range ,70 - 120 min） , and the average blood loss was 150 ml （range,90-400 ml）. One-stage incision healing was obtained in all patients. All the patients were followed up for 12-24 months （average, 18. 2 months）. During the follow-up one year after operation, VAS for low back pain decreased from preoperative 6.8 ± 2.6 to postoperative 2.7 ± 1.3, and VAS for leg pain decreased from preoperative 8.1 ± 2.4 to postoperative 2.9 ± 1.4. Based on Nakai criteria,25 cases were rated as excellent, 12 cases were rated as good and 3 cases were rated as fair. The excellent and good rate was 92. 5% （37/40）. No complications such as screw loosening, screw breaking or cage displacement occurred. Conclusions Unilateral pedicle screw combined with contralateral translaminar facet screw fixation in transforaminal lumbar interbody fusion through transmutifidus approach under Mast Quadrant has the advantages of minimal invasion,less blood loss, less complications and reliable curative effect. It is optimal choice for partial low lumbar degenerative diseases.