Metrx Quadrant 可扩张通道管微创系统在腰椎滑脱手术中的初步应用

Metrx quadrant system in the surgery of lumbar spondylolisthesis： preliminary clinical application

目的 评价 Quadrant 可扩张系统下腰椎后路融合结合椎弓根内固定手术治疗腰椎滑脱症的临床疗效及微创性.方法 61例腰椎滑脱症患者,随机分为两组：微创组为 Quadrant 后路微创撑开系统辅助下手术（30例）;开放组为传统后路开放手术（31例）.分别于术前1 d和术后3个月及1年对两组病人的VAS评分,ODI评分进行记录,以此来评估临床症状改善程度及手术疗效,同时进行影像学（椎间隙高度、植骨融合率）的观察.结果 术后3个月VAS、ODI差异有统计学意义（2.5±0.2）分比（2.9 ±0.5）分,（15.6±2.2）分比（16.4±2.8）分,P〈0.05.术后1年VAS、ODI评分差异有显著统计学意义（1.9±0.8）分比（2.2±0.9）分,（12.1±3.8）分比（14.6±3.6）分（P〈0.01）.术后3个月椎间隙高度差异无统计学意义（14.1±0.6） mm比（13.9±0.5）mm,P〉0.05.术后1年椎间隙高度差异有统计学意义（13.9±0.7）mm比（13.4 ±0.9）mm,P〈0.05.术后1年融合率差异有统计学意义（χ2=4.211,P=0.04）.结论 与传统开放手术相比,Quadrant 系统下微创术从保护脊柱的稳定性、术后康复,影像学的变化上,都显示很大优势,作为脊柱微创技术值得推广.

Objective To evaluate the clinical efficacy and minimal invasiveness of quadrant posterior distraction system in the posterior lumbar spondylolistbesis （LS） surgery.Methods Sixty-one LS paftients were randomly divided into two groups：quadrant posterior minimally invesive surgery system as invesive group （n=30） and traditional open surgery as open group （n=31）.The clinical outcome of pain relief Was assessed by the scoring systems of visual analogue scale （VAS） and Oswestry disability index （ODI） for low back pain.Radiographic assessment：preoperative and 1-day,3-month and last follow-up （12 months） radiographs were analyzed including the index of relative posterior disc height. Results The scores of VAS and ODI of invasive group were less than open group at Months 3 and 12 post-operation （P〈0.01）.Relative posterior disc height of intra-operation and Month 3 was not significantly different （P〉0.05）.And there was only statistical significance difference within 12 months （P〈0.05）.At Month 12 post-operation.the fluctuating rate was slight. Condusion The minimally invasive operation with Quadrant is less traumatic to the patients traditional open operation in the protection of spinal stability,postoperative rehabilitation and radiographs.This new minimally invasive spine technique should be popularized.