Quadrant微创系统下行单侧椎弓根螺钉内固定联合椎间植骨融合治疗极外侧型腰椎间盘突出症的临床疗效观察

Effect of Quadrant minimally invasive system applied to unilateral transpedicular internal fixation with screw combined with intervertebral bone grafting fusion on far-lateral lumbar disc herniation

目的探讨Quadrant微创系统单侧椎弓根螺钉内固定椎间植骨融合治疗极外侧型腰椎间盘突出症的疗效。方法对20例极外侧型腰椎间盘突出症患者通过Quadrant微创通道下单侧椎弓根螺钉内固定及椎间植骨融合内固定术,运用日本骨科学会评估治疗分数(JOA评分)和疼痛评估伤口视觉模拟法(VAS评分)评价疗效,并观察术后各项指标。结果20例患者均顺利完成手术,均按时门诊复查,平均随访26个月。随访腰椎正侧位及过伸过曲位X线片、腰椎CT及腰椎MRI检查示内固定器稳定,未出现腰椎失稳,20例病例植骨完全融合。临床疗效为优16例,良3例,可1例,无效0例。末次随访JOA评分明显高于术前(P<0.05),腰痛、腿痛VAS评分明显低于术前(P<0.05);术前与末次随访椎间隙高度比较,差异无统计学意义(P>0.05)。结论 Quadrant系统下行单侧椎弓根螺钉内固定联合椎间植骨融合内固定术治疗极外侧型腰椎间盘突出症可维持术后的脊柱稳定性,具有损伤小、出血少、恢复快、疗效满意且操作简单等优点。

Objective To investigate the effect of Quadrant minimally invasive system applied to unilateral transpedicular internal fixation with screw combine with intervertebral bone grafting fusion on far-lateral lumbar disc herniation （FLLDH）.Methods Twenty patients with FLLDH underwent unilateral transpedicular internal fixation with screw assisted by Quadrant minimally invasive system combined with intervertebral bone grafting fusion .Japanese Orthopaedic Association （ JOA） questionnaire and visual analogue scale （ VAS） were adopted to evaluate the clinical efficacy .The postoperative indexes were observed .Results Twenty patients received the surgery successfully and were followed up at the clinic on time ,with the average follow-up of 26 months.The results of X-ray in the right and lateral view, over-extending and over-bending view of lumbar spine , lumbar CT and MRI showed that internal fixators were stable , no lumbar instability cases occurred ,20 cases of complete fusion of bone grafting were observed .The excellent effect was achieved in 16 cases,better in 3 cases,good in 1 case,and no inefficacy cases .The JOA scores were significantly higher while the VAS scores of lumbocrural pains were significantly lower in the final follow-up compared with the preoperative （P＆lt;0.05）,but the height of intervertebral space showed no significant difference（P＆gt;0.05）.Conclusion Quadrant minimally invasive system applied to unilateral transpedicular internal fixation with screw combined with intervertebral bone grafting fusion might maintain the postoperative spinal stability for FLLDH with the advantages of less damage,less bleeding,quicker recovery,satisfactory effects and being easy-operated.