Quadrant通道下经Wiltse入路微创治疗老年极外侧腰椎间盘突出症

目的探讨Quadrant通道下经Wiltse入路微创治疗老年极外侧腰椎间盘突出症的临床效果。方法入选手术治疗的老年极外侧腰椎间盘突出症患者33例，其中采用Quadrant通道下经Wiltse入路微创治疗18例（Quadrant通道组），采用椎间孔镜治疗15例（椎间孔镜组）。记录手术时间、术中出血量、切口长度；术前、术后1周、术后3个月、术后12个月、术后24个月日本骨科协会（JOA）评分，并进行比较。结果除Quadrant通道组1例失访外，两组患者均随访24个月。Quadrant通道组无手术并发症发生，椎间孔镜组1例术中发生神经根挫伤，术后积极治疗后症状消失。Quadrant通道组切口长度（2．0～2．5em）大于椎间孔镜组（0．7cm）。Quadrant通道组术中出血量大于椎间孔镜组[（46．50±15．20）ml比（23．87±6．58）m1]，但手术时间短于椎间孔镜组[（63．20±10．87）min比（77．17±8．71）min]，差异有统计学意义（P〈0．01）。两组术后各时间点JOA评分均明显高于术前，差异有统计学意义（P〈0．01）；椎间孔镜组术后1周JOA评分优于Quadrant组，差异有统计学意义（P〈0．01），但两组术后3，12，24个月比较差异无统计学意义（P〉0．05）。结论应用Quadrant通道下经Wiltse入路微创治疗老年极外侧腰椎间盘突出症是一种有效的方法，可达到同椎间孔镜手术相近的手术效果。

Objective To explore the clinical effect of the elderly far lateral lumbar disc herniation via Quadrant channel system under the Wiltse approach. Methods Thirty-three elderly patients suffering from far lateral lumbar disc herniation were treated by surgery, among whom 18 patients were treated by Quadrant minimally invasive channel system (Quadrant group), and 13 patients were treated by percutaneous transforaminal endoscopic discectomy (PTED group). The patients were followed up for 12 months, and the operation time, blood loss and length of incision were investigated. The JOA scores were compared preoperatively and postoperatively. Results The patients in two groups were followed up for 24 months, except 1 patient withdrew in Quadrant group. The incision length and blood loss in PTED group were superior to those in the Quadrant group:2.0-2.5 cm vs. 0.7 cm, (46.50± 15.20) ml vs.(23.87±6.58) ml, P<0.01, but the operation time in PTED group was longer than that in Quadrant group: (77.17 ± 8.71) min vs. (63.20 ±10.87) min, P<0.01.The two groups had achieved good curative effect, while JOA score in PTED group was superior to the Quadrant group 1 week after operation ( P<0.05), but in 3 month and 12 month two groups had no significant difference ( P>0.05). Conclusion Surgical treatment on elderly far lateral lumbar disc herniation via quadrant channel under wiltse approach is an effective method, and can achieve similar effect with PTED.