Quadrant通道下微创腰椎后路融合术治疗单节段腰椎退行性疾病

Treatment of minimally invasive posterior lumbar interbody fusion via Quadrant channel for single-segment degenerative lumbar spine diseases

目的探讨Quadrant通道下微创腰椎后路融合术治疗单节段腰椎退行性疾病的临床效果。方法回顾性分析2014年11月至2016年3月南京医科大学附属苏州医院收治的12例单节段腰椎退行性疾病的临床资料，所有患者均在Quadrant通道下经多裂肌与最长肌间隙行微创腰椎后路融合手术。其中腰椎后路椎体间融合10例、腰椎后外侧融合2例。记录手术时间、术中出血量、术后引流量、术后血红蛋白水平，以及术前、末次随访时疼痛视觉模拟量表（VAS）评分和Oswestry功能障碍指数（ODI）。结果手术时间120～260min，平均手术时间180min；术中出血量50～800mL，平均术中出血量375mL；术后引流量8～321mL，平均引流量128mL；术后血红蛋白水平93～138g/L，平均血红蛋白水平113g/L。所有患者无脑脊液漏、神经根损伤、感染及术后顽固性腰背痛发生。随访5～21个月（平均16个月），术前、术后末次随访VAS评分和ODI分别为（6.4±1.0）、（2.0±0.7）分和（18±4）、（46±10）分，手术前后比较，差异均有统计学意义（P＜0.05）。结论Quadrant通道下经多裂肌与最长肌间隙入路行腰椎后路融合手术治疗单节段腰椎退行性疾病具有出血少、对后方韧带破坏小、脊柱稳定性好、功能恢复快等优点，符合微创理念，值得临床推广应用。

Objective To investigate the clinical effect of minimally invasive posterior lumbar interbodyfusion via Quadrant channel in the treatment of single-segment degenerative diseases of lumbar spine. MethodsTwelve patients with single-segment lumbar degenerative diseases treated in Suzhou Affiliated Hospital ofNanjing Medical University from November 2014 to March 2016 were included in the study, who underwentminimally invasive posterior lumbar interbody fusion via the gap of multifidus muscle and the longest muscleunder Quadrant channel, including 10 patients with posterior lumbar interbody fusion and 2 patients with posterolateral fusion. Their clinical data were retrospectively analyzed. Operation time, intraoperative blood loss,postoperative drainage volume, postoperative hemoglobin level, pain visual analogue scale (VAS) score andOswestry disability index (ODI) before and after the surgery were recorded. Results Operation time was 120 to260 min, with an average of 180 min. Intraoperative blood loss was 50 to 800 mL (average, 375 mL).Postoperative drainage volume was 8 to 321 mL (average, 128 mL). The hemoglobin level was 93 to 138 g/L,and the mean value was 113 g/L. No cerebrospinal fluid leakage, nerve root injury, infection or intractable lowback pain was found in all patients. After 5 to 21 month' follow-up (average, 10 months), the average score ofVAS and ODI was (2.0 ± 0.7) points and (46 ± 10) points, showed improvement compared with preoperative (6.4± 1.0) points and (18 ± 4 points). The differences between preoperation and the last follow-up had statisticalsignificance (P <0.05). Conclusion For single-segment degenerative lumbar spine diseases, posterior lumbarinterbody fusion via the gap of multifidus muscle and the longest muscle under Quadrant channel has theadvantages of less blood loss, less damage to the posterior ligaments, better spinal stability, faster postoperativerecovery, which is consistent with minimally invasive concept and worthy of clinical application.