Quadrant系统辅助下MIS-TLIF联合峡部截骨治疗腰椎管狭窄症的临床疗效

Clinical effect by Quadrant system-assisted MIS-TLIF combined with isthmic osteotomy in the treatment of lumbar spinal stenosis

目的探讨Quadrant辅助下微创经椎间孔腰椎椎体间融合术(MIS-TLIF)联合非减压侧椎板峡部截骨与传统开放经椎间孔腰椎椎体间融合术(TLIF)治疗腰椎管狭窄症的疗效。方法 40例腰椎管狭窄症患者,按治疗方式不同分为A组和B组,各20例。A组给予MIS-TLIF联合椎板峡部截骨治疗,B组给予传统开放TLIF治疗。比较两组手术时间、术中出血量、术后视觉模拟评分法(VAS)评分、病变椎间隙高度变化、腰椎前凸角变化。结果 B组有1例患者术中因椎间隙狭窄严重,在置入融合器时将cage融合器打入下位椎体中,经过植骨再次调整后cage融合器位置恢复良好。A组手术时间为(144.50±4.50)min,术中出血量为(193.00±67.12)ml,优于B组的(156.25±11.68)min、(322.50±65.84)ml,差异有统计学意义(P<0.05)。A组手术前VAS评分为(5.80±0.95)分,手术后为(1.25±0.44)分,B组手术前为(5.75±0.90)分,手术后为(1.30±0.47)分;两组手术后VAS评分均优于手术前,差异有统计学意义(P<0.05),但两组手术后VAS评分比较差异无统计学意义(P>0.05)。A组术前腰椎前凸角为(25.15±4.70)°,术后为(45.30±4.44)°;B组分别为(26.80±4.21)、(36.20±4.53)°;两组术后前凸角均较术前明显好转,且A组优于B组,差异有统计学意义(P<0.05)。A组术前椎间隙高度为(5.41±0.98)mm,术后为(10.45±1.18)mm,B组分别为(5.53±0.57)、(8.93±0.57)mm;两组术后椎间隙高度均较术前明显好转,且A组优于B组,差异有统计学意义(P<0.05)。结论 Quadrant辅助下MIS-TLIF联合椎板峡部截骨治疗腰椎管狭窄症,既具有微创手术优势,同时能更好的恢复椎间隙高度及前凸角的度数,且手术时间短,术中出血量少,值得临床推广应用。

Objective To investigate curative effects by Quadrant system-assisted minimally invasive transforaminal lumbar interbody fusion （MIS-TLIF） combined with non-decompression lateral vertebral plate isthmic osteotomy and conventional open transforaminal lumbar interbody fusion （TLIF） in the treatment of lumbar spinal stenosis. Methods A total of 40 patients with lumbar spinal stenosis were divided by different treatment measures into group A and group B, with 20 cases in each group. Group A received MIS-TLIF combined with vertebral plate isthmic osteotomy for treatment, and group B received conventional open TLIF for treatment. Comparison was made on operation time, intraoperative bleeding volume, postoperative visual analogue scale （VAS） score, change of intervetebral space height and lumbar lordosis angle between the two groups. Results There was 1 case in group B receiving expandable cage in inferior vertebral body due to severe narrow intervertebral space, and readjustment after bone grafting showed good recovery. Group A had operation time as （144.50 ± 4.50） min and intraoperative bleeding volume as （193.00 ± 67.12） ml, which were all better than （156.25 ± 11.68） min and （322.50 ± 65.84） ml in group B, and the difference had statistical significance （P〈O.05）. Group A had VAS score as （5.80 ± 0.95） points before operation and （1.25 ± 0.44） points after operation. Group B had VAS score as （5.75 ± 0.90） points before operation and （1.30 ± 0.47） points after treatment. Both groups had better postoperative VAS scores than those before operation, and the difference had statistical significance （P〈O.05）, while the difference of postoperative VAS scores had no statistical significance between the two groups （P〉O.05）. Group A had lumbar lordosis angle as （25.15± 4.70）° before operation and （45.30 ± 4.44）° after operation, which were respectively （26.80 ± 4.21） and （36.20 ± 4.53） ° in group B. Both groups had better lumbar lordosis angle after operation, and group A had better improvement than group B, and their difference had statistical significance （P〈0.05）. Group A had intervetebral space height as （5.41 ± 0.98） mm before operation and （10.45 ± 1.18） mmafter operation, which were respectively （5.53 ± 0.57） and （8.93 ± 0.57） mm in group B. Both groups had better intervetebral space height after operation, and group A had better improvement than group B, and their difference had statistical significance （P〈0.05）. Conclusion Quadrant system-assisted MIS-TI,IF combined with vertebral plate isthmic osteotomy in the treatment of lumbar spinal stennsis contains advantage of minimal invasion, and it can bring remarkable recovery of intervetebral space height and lumbar lordosis angle, along with short operation time and little intraoperative bleeding volume. This method is worth clinical promotion and application.