Quadrant系统辅助微创治疗腰椎滑脱症的前瞻性疗效分析

Minimally invasive treatment of lumbar spondylolisthesis assisted by Quadrant system

[目的]前瞻性比较分析Quadrant系统辅助改良TLIF微创治疗腰椎滑脱症的临床疗效。[方法]2008年4月～2010年4月，单节段腰椎滑脱患者共76例，男41例，女35例；年龄27—72岁，平均52岁。患者随机分为两组行改良TLIF手术以及传统PLIF手术。术后观察切口长度，手术时间，出血量及并发症，滑脱角、Taillard指数，腰椎cT以判定植骨融合率。术后3个月MRI检查多裂肌节段，评价融合节段多裂肌损伤情况。临床结果评定采用末次随访VAS评分及ODI评分，按改良MacNab分级评定优良率。[结果]所有病例均顺利完成手术，两组患者腰痛和下肢放射性麻痛等临床症状均有效缓解，在术后1个月腰痛缓解程度（VAS）、生活质量改善（Oswestry）、手术时间、术中出血量、住院时间和术口长度等方面，改良TLIF组均优于传统PLIF组（P〈0．05）。术后随访18—50个月，平均26．4个月，患者末次随访时滑脱角、Taillard指数与术前比较均明显改善，差异均有统计学意义，所有患者均获骨性融合，5例获可疑融合，融合率93．4％。末次随访时疼痛的VAS评分、ODI评分较术前明显改善，差异均有统计学意义，改良MacNab分级评定优良率，微创改良TLIF组92．1％，传统PLIF组为94．7％，两组间无统计学差异。术后3个月微创改良TLIF组12例患者接受腰椎MRI手术节段扫描，T2弛豫时间为（102．8±16．46）ms，PLIF组14例患者他弛豫时间为（314．5±25．61）ms，两组间有显著的统计学差异（P=0．000〈0．05）。[结论]改良TLIF术式创伤更小，术后康复快，是治疗腰椎滑脱症的一种理想的微创手术方法。

[ Objective ] To prospectively explore the clinical efficacy of Minimally invasive treatment of lumbar spondylolisthesis using modified TLIF technique assisted by Quadrant system. [ Methods] From April 2008 to April 2009, 76 patients of single - level lumbar spondylolisthesis were divided into two groups randomly, and accepted Quadrant system assisted transforaminal lumbar interbody fusion （TLIF） and tranditional posterior lumbar interverbody fusion （PLIF） operation. The skin incision length, operative time, blood loss and complication were observed. Posterior radiological evaluation was applied to evaluate the slipping angle, Taillard index and T2 relaxation time of the operative level in post - operative 3 months MRI image. The visual analogue scores （VAS） and Oswestry disablility index （ODI） scores and MacNab grade were used for clinical assessment. [ Results] All patients were operated successfully and got different content alleviation of the symptoms. Improved TLIF group were better than PLIF group in the average skin incision length, the average operative time, the average blood loss and length of stay with siguifieant difference. All cases were followed up for 18 - 50 months （average 26.4 months） . The complication occurred in 5 cases. At final followed - up the radiography showed that the slipping angle Taillard index all improved compared with those before operation, and 71 cases got bone fusion, 5 cases got suspicious fusion with the fusion rate of 93.4%. Improved TLIF group were better than PLIF group in the average VAS , ODI score in the one - month follow - up, with siguifieant difference. However, At final followed - up, there wasn＇ t significant difference. [ Conclusion ] Minimally invasive treatment of lumbar spondylolisthesis assisted by Quadrant system by improved TLIF operation has the merit of minimal invasive, less blood loss, quicker recovery, less complications. The clinical effect is satisfactory.