管状牵开器辅助下单侧固定治疗复发性腰椎间盘突出症的临床观察

目的评估微创Quadrant通道下单侧内固定治疗复发性腰椎间盘突出症的临床疗效。方法选择2012年1月~2014年12月在我院手术治疗的18例腰椎间盘突出症术后复发患者,经后路单侧肌间隙入路,微创Quadrant通道下行单侧椎弓根内固定+椎间融合术。Oswestry功能障碍指数(ODI)及疼痛视觉类比评分(VAS)对患者再次手术前、手术后进行临床疗效评价,腰椎CT检查评估是否椎体间融合。结果所有的患者均随访6~25个月,平均12.6个月。术前VAS平均评分为7.31±1.6分,术后末次随访VAS平均评分为3.15±0.54分,与术前比较差异有统计学意义(P0.05)。ODI评分术前平均38.54±3.21分,术后末次随访平均为5.96±3.12分,与术前比较差异有统计学意义(P0.05)。末次随访椎体间植骨均融合,无椎弓根螺钉断裂和融合器移位。结论微创Quadrant通道下单侧内固定治疗复发性腰椎间盘突出症安全有效。

Clinical outcome of invasive interbody fusion under Quadrant system for lumbar disc herniation

［Abstract］ Objective To evaluate preliminary clinical efficacy of minimally invasive posterior lumbar spine interbody fusion under Quadrant system for lumbar disc herniation. Methods From January 2012 to December 2014, a total of 18 cases suffering from lumbar disc herniation were implemented surgery. These cases underwent interbody fusion via bilateral paramedian approach under Quadrant invasive system. ODI and VAS score was used to evaluate the pre?and post?revision operation outcome Lumbar CT scan and three?dimensional reconstruction was used to assess the lumbar interbody fusion. Results Thirty?six patients were followed up for 6?25 months（mean, 12.6 months）. The mean VAS score at preoperation was 7.31±1.6, the last follow?up after operation average VAS score was 3.15± 0.54, which showed statistical significance（P<0.05）. Preoperative averaged ODI score was 38.54±3.21, the last follow?up after operation averaged ODI score was 5.96±3.12, there are differences compared with preoperative statistical significance （P<0.05）. All cases got bony fusion in the last follow-up after operation. No breakage of pedicle screws and fusion device shift were noted. Conclusion The Quadrant channel of minimally invasive lumbar interbody fusion in the treatment of lumbar disc herniation is safe and effective.