可扩张微创通道管系统下单切口治疗退行性腰椎管狭窄症

MAST-QUADRANT Channel System for Degenerative Lumbar Spinal Stenosis

目的探讨采用MAST-QUADRANT可扩张微创通道管系统下单切口治疗退行性腰椎管狭窄症的疗效。方法 2009年6月～2011年6月对28例退行性腰椎管狭窄症在MASTQUADRANT通道下行单切口髓核切除+神经根管扩大+椎弓根螺钉固定+椎间植骨融合术。结果手术时间(180±36)min,出血量(195±74)ml,所有患者均未输血。2例切口皮肤暗红;1例硬脊膜损伤。VAS评分由术前(6.8±1.7)分降至术后7 d(1.3±0.5)分(P=0.00)。28例随访6～18个月,平均13.6月,末次随访时采用MacNab疗效评价标准评价手术效果,优17例,良9例,可2例,优良率92.8%(26/28)。结论在严格掌握手术适应证的情况下,MAST-QUADRANT可扩张微创通道管系统下单切口技术是治疗退行性腰椎管狭窄症安全有效的微创方法。

Objective To evaluate the efficacy of MAST-QUADRANT channel endoscopic single-incision technique for minimally invasive treatment of degenerative lumbar spinal stenosis. Methods From June 2009 to June 2011, 28 patients with degenerative lumbar spinal stenosis received QUADRANT channel single-incision discectomy ＋ dialation of the nerve root canal ＋ pedicle screw fixation ＋ interbody fusion, in our hospital. The operation time, intraoperative blood loss, postoperative complications, pain relief, and efficacy of the surgery were evaluated. Results The mean operation time was （180 ± 36） min, and mean intraoperative blood loss was （195± 74） ml, none of the patients received blood transfusion. Two patients showed dark wound skin, and one patient developed dural injury. VAS decreased from 6.8 ± 1.7 preoperatively to 1.3 ± 0.5 in seven days after the procedure （P = 0. 00）. The patients were followed up for a mean of 13.6 months （ranged from 6 to 18 months）, the MacNab evaluation carried out at the last follow-up showed excellence in 17 patients, good in 9, and improved in 2. The rate of excellence and good was 92.8% （26/28）. Conclusion With restrict control of surgical indication, MAST-QUADRANT channel endoscopic single-incision technique is safe and effective for degenerative lumbar spinal stenosis.