Mast Quadrant微创通道与开放式经椎间孔腰椎椎间融合术的临床比较

Clinical comparison between minimal invasive transforaminal lumbar interbody fusion with Mast Quadrant and open transforaminal lumbar interbody fusion

目的比较Mast Quadrant微创通道与开放式经椎间孔腰椎椎间融合术(transforaminal lumbar interbody fusion,TLIF)治疗腰椎椎间盘突出症伴节段性不稳的临床疗效。方法回顾分析行TLIF手术治疗的65例腰椎椎间盘突出伴节段不稳的临床资料,根据手术方式分为行传统TLIF的开放组(44例)及使用Mast Quadrant通道行TLIF手术的微创组(21例)。比较微创组与开放组出血量、手术时间、住院时间以及手术前后的视觉模拟量表(visual analog scale,VAS)评分和日本骨科学会(Japanese Orthopaedic Association,JOA)评分。结果微创组围手术期出血量、手术时间以及住院天数均较开放手术组少(短),差异有统计学意义(P<0.05)。2组末次随访时疼痛VAS和JOA评分均较术前有改善,差异有统计学意义(P<0.05)。2组之间疼痛VAS评分比较,差异亦有统计学意义(P<0.05)。结论与传统开放手术相比较,应用Mast Quadrant通道不但同样能够完成椎管减压、椎间植骨融合、椎弓根螺钉内固定等操作,还具有切口小、出血少、住院时间短、术后恢复快、发生下腰痛概率低等优点,是手术治疗腰椎椎间盘突出症伴节段不稳更好的选择。

Objective To eompare the curative eftct between nfinimal invasive transformninal lumbar interbody fusion （TLIF） with Mast Quadrant and open TLIF. Methods A total of 65 cases suffered from lumbar disc herniation with segmental instability performed with TLIF were retrospectively investigated. The patients were divided into 2 groups according to the different surgical procedure： open TLIF group and minimal invasive TLIF （MI-TLIF） group. The bhrod loss, operation time and hospital duration, visual anlog scale （VAS） and Japanese Orthopaedic Association （JOA） scores before and ＇after operation were recorded and st＇atis tically compared respectively. Results The different of the wlume of blood loss, operation time and hospital duration between the 2 groups were statistically significant （P 〈0.05）. The VAS and JOA scores in both groups at the final follow-up were improved sig- nificantly compared with those before operation （P 〈0.05）. And the VAS score was lower in MI-TLIF group at the final follow-up than that in open TLIF group （P 〈0.05）, while JOA scores at the final follow-up was not statistically significant different between the 2 groups （P 〉0.05）. Conclusion Compared with traditional open operation, MI-TLIF with Mast Quadrant dilator not only has the advantage of complete decompression of the spinal canal, interbody fusion, pedicle screw fixation, but also has advantages of less invasive, shorter hospitalization stay and less postoperative pain, it is a better choice for the treatment of lumbar disc herniation with segmental instabihty.