Quadrant通道辅助下椎间融合术治疗重度中央型腰椎间盘突出症

Minimally invasive lumbar inter body fusion via MAST Quadrant retractor versus traditional PLIF procedure in patients with one level severe central lumbar disc herniation

目的：比较Quadrant通道辅助下椎间融合术与传统腰椎后路椎体间融合术（PLIF）治疗重度中央型腰椎间盘突出症的临床疗效.方法：回顾分析2009年9月～2011年9月重度中央型腰椎间盘突出症患者共43例,其中接受Quadrant通道辅助下椎间融合术15例,传统PLIF手术治疗28例.采用VAS评分、JOA评分及Macnab标准评估临床疗效,比较2组术中术后指标及并发症情况.结果：2组平均随访＞12个月,VAS评分及JOA评分2组术后3个月及末次随访时较术前均显著改善（均P＜0.05）,组间比较无显著性差异（均P＞0.05）.术中出血量及术后卧床时间Quadrant组均显著少于传统PLIF组（均P＜0.05）.所有患者术后末次随访时影像学检查内固定均无松动和断裂.术后并发症：传统PLIF手术组出现硬膜损伤1例、切口血肿2例;Quadrant组术后即刻出现下肢肌力减退1例.结论：Quadrant手术治疗重度中央型腰椎间盘突出症与传统PLIF手术的临床疗效接近,具有手术创伤小、术中出血少、术后恢复快等优点.

Objective：To compare minimally invasive lumbar inter body fusion via MAST Quadrant retractor with traditional posterior lumbar interbody fusion （PLIF）proeedure in patients with severe central lumbar disc herniation in terms of clinical outcomes and complications.Methods：From September 2009 to September 2011, the data of 43 patients with single level sever central disc herniation were retrospectively studied.Fifteen pa- tients underwent Quadrant channel assisted inter body fusion surgery and 28 patients underwent traditional PLIF procedure.Visual analog scale（VAS）,JOA score and Macnab score were adopted to evaluate the surgical efficacy.Results：The followed-up time of patients in both groups were over 12 months.Compared with preop- eration,VAS scores in both groups improved significantly both in three months post the operation and at latest follow-up.There was no significant difference between the two groups in VAS scores （P〉0.05）.The same result was found in JOA scores.Blood loss,time in bed post-operation of Quadrant group were significantly less than that in traditional PL/F group（P〈O.O5）.Non fusion failure and fracture of internal fixation happened during the follow-up period.In traditional PLIF group one patient suffered from dural mater leakage and two patients un- derwent postoperative wound hematoma.In Quadrant group one patient suffered from lower extremity muscle strength decline immediately after operation.Conclusion：Lumbar inter body fusion via MAST Quadrant retractor technique is as effective as traditional PLIF procedure in dealing with severe central lumbar disc herniation with advantages of less bleeding,rapid postoperative recovery and a short time in bed postoperatively.