经肌间隙入路微创治疗腰椎滑脱症的疗效

Minimally invasive treatment of lumbar spondylolisthesis assisted by Quadrant system

目的 探讨Quadrant系统辅助经肌间隙入路改良经椎间孔入路椎间植骨融合术（TLIF）微创治疗腰椎滑脱症的临床疗效.方法 单节段腰椎滑脱患者共86例,男41例,女35例,年龄32～ 76岁,平均51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检查来判定植骨融合率.并用术后3个月MRI检查多裂肌节段,评价融合节段多裂肌损伤.临床结果评定采用视觉模拟评级法（VAS）评分及Oswestry功能障碍指数问卷表（ODI）评分,按改良MacNab分级评定优良率.结果 两组患者临床症状均有效缓解,在手术时间、术中出血量、住院时间和术口长度,术后1个月VAS、生活质量改善（Oswestry）等方面,改良TLIF组均优于传统PLIF组（P＜0.05）.术后随访20 ～ 56个月,平均29.6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,81例患者获骨性融合,5例获可疑融合,融合率为94.2％.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（P＜0.05）,改良MacNab分级评定优良率微创改良TLIF组93.0％,传统PLIF组为95.36％,两组间差异无统计学意义（P＞0.05）.术后3月微创改良TLIF组21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23例患者T2弛豫时间为（314.5±25.61） ms,两组间差异有统计学意义（P＜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 transforaminal lumbar interbody fusion （TLIF） technique assisted by Quadrant system.Methods From April 2008 to April 2012,86 patients with single-level lumbar spondylolisthesis were divided into two groups randomly,and accepted Quadrant system assisted TLIF and tranditional posterior lumbar interverbody fusion （PLIF） operation.The skin incision length,operative time,blood loss and complications were observed.Posterior radiological evaluation was done by the slipping angle,Taillard index and T2 relaxation time of the operative level in post-operative 3-month magnetic resonance imaging （MRI） images.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 was superior to PLIF group in the average skin incision length,the average operative time,the average blood loss and length of hospital stay.All cases were followed up for 20-56 months （average 29.6 months）.The complication occurred in 5 cases.At the final followed-up the radiography showed that the slipping angle Taillard index was improved compared with that before operation,and 81 cases got bone fusion,and 5 cases got suspicious fusion with the fusion rate of 94.2％.Improved TLIF group was superior to PLIF group in the average VAS and ODI scores one month after operation.However,at the final followed-up there was no significant difference.Conclusion Minimally invasive treatment of lumbar spondylolisthesis assisted by Quadrant system by improved TLIF operation has the merit of minimal invasion,less blood loss,quicker recovery,and less complications.The clinical efficacy was satisfactory.