Quadrant辅助下TLIF治疗腰椎退变性疾病

Transforaminal lumbar interbody fusion under Quadrant system for treatment of lumbar degenerative diseases

[目的]探讨采用常规腰椎固定系统经椎旁肌间隙入路Quadrant辅助下经椎间孔椎体间融合(TLIF)治疗腰椎退变性疾病临床疗效。[方法]回顾性分析37例采用本手术方式治疗的腰椎退变性疾病患者,椎旁小切口Quadrant辅助下肌间隙入路,行患侧关节突切除,减压后椎体间融合,常规固定系统固定。术前、术后3个月及末次随访时采用疼痛视觉模拟评分(VAS)和Oswestry功能障碍指数(ODI)分别评估患者疼痛、神经功能情况,影像学检查评估椎体间融合情况。[结果]所有患者均完成1年以上随访时间,患者VAS、ODI和术前相比获得较好的改善(P<0.05),影像学数据显示骨性融合率为84.4%。[结论]采用常规腰椎固定系统经椎旁肌间隙入路Quadrant辅助下TLIF治疗腰椎退变性疾病,手术损伤小、手术费用低,并有良好的临床疗效。

[Objective] To explore the clinical efficacy of transforaminal lumbar interbody fusion（ TLIF） under Quadrant system through Wiltse approach associated with conventional lumbar fixation instrument for surgical management of lumbar degenerative diseases. [Methods] A retrospective analysis was performed in 37 patients with lumbar degenerative disease,who underwent the following surgical procedures. Through paravertebral small incisions Wiltse approaches were established under Quadrant system,subsequently,resection of fecet joints,decompression,interbody fusion and fixation with conventional fixation system（ rods and pedical screws） were performed successively. The patients were evaluated using pain visual analogue scale（ VAS） and Oswestry disability index（ ODI） preoperatively,3- month postoperatively and at last follow- up respectively. Vertebral fusion was assessed by radiological examination. [Results] All the patients were followed up for more than 1year. VAS and ODI scores significantly improved at 3 months postoperatively（ P〈0. 05）. Twenty- seven segments（ 84. 4%）achieved fusion. [Conclusion] Treatment of lumbar degenerative diseases by TLIF using conventional lumbar fixation system through Wiltse paravertebral approach can achieve good clinical outcomes with low surgery related injury and low operation cost.