微创Quadrant通道下椎间融合术治疗复发性腰椎间盘突出症的初步疗效

Preliminary outcome of intervertebral fusion under Quadrant minimally invasive system for treatment of recurrent intervertebral lumbar disc herniation

目的评价腰椎后路微创Quadrant通道下椎间融合术治疗复发性腰椎间盘突出症的初步临床疗效。方法 2010年1月-2012年12月,我科收治25例复发性腰椎间盘突出症患者,采用后路原切口双侧肌间隙入路（Wiltse入路）,经微创Quadrant通道下行椎间融合术。应用Oswestry功能障碍指数（ODI）及疼痛视觉类比评分（VAS）对患者再次手术前、手术后进行临床疗效评价,腰椎薄层CT扫描及三维重建评估椎体间融合。结果 25例患者均获得随访,随访的时间为12-36个月,平均19.2个月。术前VAS平均评分为8.26±1.4分,术后末次随访VAS平均评分为2.47±0.65分,与术前比较差异有统计学意义（P〈0.05）。ODI评分术前平均40.32±3.14分,术后末次随访平均为6.67±2.54分,与术前比较差异有统计学意义（P〈0.05）。末次随访椎体间植骨均融合,无椎弓根螺钉断裂和融合器移位。结论微创Quadrant通道下椎间融合术治疗复发性腰椎间盘突出症安全有效。

Objective To evaluate preliminary clinical efficacy of minimally invasive posterior lumbar spine interbody fusion under Quadrant system for recurrent lumbar disc herniation. Methods From January 2010 to December 2012,a total of 25 cases with recurrent lumbar disc herniation were implemented surgery. The patients underwent interbody fusion via bilateral paramedian approach under Quadrant invasive system. ODI and VAS score were used to evaluate the pre-and post-revision operation outcome. Lumbar CT scan and three-dimensional reconstruction were used to assess the lumbar interbody fusion. Results Twenty five patients were followed up for 12-36 months（mean,19.2 months）. The VAS score at preoperation was 8.26 ±1.4, and 2.47 ±0.65 at last follow-up after operation, which showed statistical significance（P〈0.05）. ODI score preoperative and the last followup after operation were 40.32＋3.14 and 6.67±2.54（P〈0.05）, respectively. All cases got bony fusion in the last follow-up after operation. No breakage of pedicle screws or fusion device shift was noted.Conclusions It is safe and effective by using the Quadrant minimally invasive system for lumbar interbody fusion in the treatment of recurrent lumbar disc herniation.