经微创通道单侧椎弓根置钉联合经椎间孔入路腰椎体间融合术治疗腰椎间盘突出症

Minimally Invasive Unilateral Pedicle Screw Fixation and Transforaminal Lumbar Interbody Fusion for Lumbar Intervertebral Disc Herniation

目的：探讨经Quadrant微创通道单侧椎弓根置钉联合单枚cage经椎间孔入路腰椎体间融合术在腰椎间盘突出症中的疗效及并发症的预防。方法对31例腰椎间盘突出症患者采用全层切开法实施经Quadrant微创通道单侧椎弓根置钉联合单枚cage经椎间孔入路腰椎体间融合术。观察手术时间、出血量、切口长度、住院时间及术后并发症情况。应用视觉模拟评分系统（VAS）评定患者术前和末次随访时的疼痛程度；末次随访采用正、侧位X线片判定植骨融合率及椎间高度，并按Nakai标准评定临床疗效。结果手术时间82～180 min，平均100 min；术中出血90～200 mL，平均120 mL；切口长度3～6 cm，平均4.5 cm；住院时间5～14 d，平均7 d；术后未出现切口区明显皮缘坏死，伤口感染等并发症。所有患者获随访，平均随访时间8个月（3～16个月）。随访期间未见椎弓根钉棒松动、断裂；末次随访疼痛VAS评分由术前（7.1±1.3）分降至（2．3±1.6）分，椎间融合率93.3%，椎间隙高度前缘由术前（1.31±0.33）cm升高到术后（1.54±0.21）cm，后缘由术前（0.55±0.11）cm升高到术后（0.65±0.10）cm。临床疗效：优15例，良11例，可5例，优良率83.87%。结论经微创通道单侧椎弓根置钉联合经椎间孔入路腰椎体间融合术具有手术时间短、出血少、对人体正常组织结构破坏小、治疗费用低等优点；全层切开法对于预防皮缘坏死，脂肪液化具有良好的临床效果。

Objective To discuss the clinical efficacy of unilateral pedicle screw fixation combined with single cage transforaminal lumbar interbody fusion via Quadrant system and the prevention of complications in lumbar intervertebral disc herniation. Methods Using full thickness cutting method, unilateral pedicle screw fixation and single cage transforaminal lumbar interbody fusion were performed via Quadrant system in 31 patients with lumbar intervertebral disc herniation. Operative time, blood loss, incision length, hospital stay and postoperative complications were observed. In addition, the degree of pain was evaluated using visual analog scale（VAS）before operation and at the last follow-up. The anteroposterior and lateral x-ray films were used to determine the fusion rate and vertebral body height and clinical efficacy was assessed with Nakai criterion at the last follow-up.Results The average operative time, intraoperative blood loss, incision length and hospital stay were 100 minutes （range, 82-180 minutes）, 120 mL （range, 90-200 mL）, 4.5 cm （range, 3-6 cm）and 7 days （range, 7-14 days）, respectively. No skin edge necrosis, wound infection and other complications were found after operation.All patients were followed up for an average of 8 months（range, 3-16 months）. No pedicle screw loosening and fracture occurred during follow-up. VAS score decreased from preoperative 7.1±1.3 to 2.3±1.6 at the last follow-up. Intervertebral fusion rate was 93.3%. Anterior vertebral height increased from preoperative（1.31±0.33）cm to postoperative（1.54±0.21）cm and posterior vertebral height increased from preoperative（0.55±0.11）cm to postoperative（0.65±0.10）cm. Clinical results were excellent in 15 patients, good in 11 and fair in 5. The excellent and good rate was 83.87%. Conclusion Minimally invasive unilateral pedicle screw fixation combined with transforaminal lumbar interbody fusion is associated with shorter operative time, less bleeding, less damage and lower cost in the treatment of lumbar intervertebral disc herniation. Full thickness cutting can effectively prevent skin edge necrosis and fat liquefaction.