新型Sextant-R系统治疗成人腰椎滑脱症的近期疗效

Short-term therapeutic effect of new Sextant-R system in the treatment of adult lumbar spondylolisthesis

目的探讨新型Sextant-R椎弓根钉系统治疗成人腰椎滑脱症的临床疗效。方法 2008-03—2010-08采用Quadrant通道下腰椎管减压、经椎间孔单枚Cage腰椎椎间融合术(微创TLIF手术)应用新型Sextant-R椎弓根钉系统提拉复位、内固定手术治疗的腰椎滑脱共21例。滑脱节段:L3滑脱3例,L4滑脱12例,L5滑脱8例。手术过程中采用症状侧Quadrant通道下腰椎管减压,新型Sextant-R经皮椎弓根钉系统提拉复位,植骨融合。对于双侧症状患者给予双侧减压,症状重侧置入单枚Cage。术后根据视觉疼痛模拟评分(VAS)评估患者术前及术后的疼痛程度,以Oswestry功能指数(ODI)评估患者术前及术后的功能恢复率,以Nakai分级评定手术疗效的优良率。结果全部21例手术顺利,单侧减压手术患者手术时间为2.5～3.5 h,平均3 h,双侧减压患者手术时间为3～4 h,平均3.5 h。术中出血400～1000 ml。全部患者获得随访,时间为6～16个月,其中随访时间≥12个月者15例。其中1例患者为术后翻修手术,出现硬膜囊破裂、脑脊液漏,给予保守疗法,无后遗症。术后1周内出现一过性下肢疼痛12例,经保守治疗1个月内缓解。手术前腿痛VAS为(7.9±3.2)分,术后3个月(3.7±2.1)分,术后6个月(2.5±1.2)分,手术前后有显著性差异(P<0.01);手术前ODI为(52.5±26)%,术后3个月(27.5±14)%,术后6个月(21.6±8)%,手术前后有显著性差异(P<0.01);根据Nakai分级,末次随访时优良率为85.7%。结论新型Sextant-R椎弓根钉系统提拉复位、内固定治疗腰椎滑脱症可较好的维持相应阶段的稳定性,安全可行,近期疗效满意。

Objective To investigate the clinical value of pedicle screw with new Sextant-R system in treating adult lumbar spondylolisthesis. Methods The 21 lumbar spondylolisthesis patients were selected and treated by decompression with Quadrant channel, transforaminal single lumbar interbody fusion （minimally invasive TLIF surgery） applying pedicle screw with new Sextant-R system to restore the lumbar by pulling it forward and internal fixation surgery. The submarining segment： 3 cases with L3 submarining, 12 with L4 submarining, 8 with L5 submarining. Decompression with Quadrant channel on the symptome side, pedicle screw with new Sextant-R system to restore the lumbar by pulling it forward, and bone graft fusion were applied in the process of the surgery. Giving those patientes with symptoms on two sides decompression on both sides, and post a single cage on the worse side was done; the ache degree of the patients before and after the surgery were evaluated according to visual ache simulating grading （VAS）, the function restoration rate of the patients before and after the surgery were done according to oswestry function index （ODI）, and the fineness rate of surgery healing efficacy according to Nakai grading. Results All operations went well. It took two and a half to three and a half hours to do one side decompression surgery with an average operating time of three hours; while that of two sides three to four hours with an average operating time of three and a half hours. The bleeding volume of patients was from 400- 1000 millilitre. All the patients were given regular follow-up which lasted 6-16 months, among whom in 15 regular follow-up time was equal to or more than 12 months. One of the patients was given an overhaul surgery after the operation due to which there were putamen fracturing and leakage of cerebrespinal fluid; then, conservative therapy was given and no sequela appeared; 15 patients were found of lower limbs ache later 1 week after the operation and the symptom was relieved later 1 month after conservative therapy. The leg ache VAS before operation was 7.9±3.2 minutes, while that after it was 3.7±2.1 minutes and 2.5±1.2 minutes 6 months after it. There were distinct differences between before and after the operation （P〈0.01）. ODI （%）before the operation was 52.5＋26 while that after it was 27.5±14 and 21.6±8 6 months after it; according to Nakai grading, the fitness rat was 85.7% at the last regular follow-up. Conclusion The treatment of adult lumbar spondylolisthesis with new Sextant-R system has satisfactory effect in minimal invasiveness and high security, which provides a safe and effective therapy for adult lumbar spendylolisthesis.