双切口Quadrant通道下微创经椎间孔椎间融合术治疗退行性腰椎疾病

Clinical observation of TLIF in double-incision under Quadrant channel in treatment of lumbar degenerative disease

目的探讨腰椎双侧小切口下普通椎弓根螺钉结合Quadrant通道下,改进微创经椎间孔椎间融合术(minimally invasive transforaminal lumbar interbody fusion,MIS-TLIF)治疗退行性腰椎疾病的临床疗效。方法回顾性分析2014年10月至2015年10月我科收治的55例退行性腰椎疾病病人,男19例,女36例;年龄为46~78岁,平均为(62.3±2.5)岁。术前常规完善腰椎正侧位及过伸过屈位X线、CT及MRI检查,影像学诊断:腰椎间盘突出症突出并不稳30例(其中6例为单纯髓核摘除术后复发),腰椎管狭窄17例,腰椎滑脱8例。病人均采用双切口Quadrant通道下改进MIS-TLIF手术治疗,双侧减压20例,单侧减压35例。通过比较术前及术后末次随访的疼痛视觉模拟量表(visual analogue scale,VAS)评分、日本骨科学会(Japanese Orthopaedic Association,JOA)腰椎评分法评定腰椎疼痛和功能改善状况,按改良Mac Nab临床评估标准评定术后疗效。结果手术切口均一期愈合。55例病人均获得随访,随访时间为12~36个月,平均为(24.2±2.2)个月。末次随访时,VAS评分由术前的(7.4±2.1)分降至(2.1±1.2)分,JOA评分由术前的(8.4±1.5)分升高至(24.5±2.3)分,术后与术前比较,差异均有统计学意义(均P<0.05)。末次随访时按改良Mac Nab标准评价疗效:优47例,良8例。随访期间病人均无复发。结论双切口Quadrant通道下TLIF治疗腰椎退行性病变疗效显著,术后复发率低。

Objective To evaluate the clinical curative effect of minimally invasive transforaminal lumbar interbody fusion(MIS-TLIF)under Quadrant channel combined with common pedicle screw with doubles mall incision in the treatment of lumbar degenerative disease.Methods The clinical data of55patients with lumbar degenerative disease from October2014to October2015were retrospectively analyzed.There were19males and36females with average age of(62.3±2.5)years old(range,46?78years old).Before the operation,MRI,CT and X-ray examinations were performed.Imaging diagnosis showed30cases of lumbar disc herniation and instability(including6cases of simple discectomy recurrence),17cases of lumbar canal stenosis,and8cases of lumbar spondylolisthesis.All patients were treated with TLIF in doubleincision under Quadrantchannel:20cases given bilateral decompression,and35cases given unilateral decompression.The VAS scoreand JOA score were compared between preoperation and postoperative last follow?up,and the improvement oflumbar pain and function was assessed.The modified MacNab criteria were used to evaluate the curative effectafter operation.Results All cases were followed up for12?36months[average of(24.2±2.2)months].At theend of the follow?up,low back pain VAS score was reduced from preoperative7.4±2.1to2.1±1.2,and JOAscore was increased from operative(8.4±1.5)to(24.5±2.3)points,at the last follow?up after operation.Thedifference was statistically significant(P<0.05).At last follow-up,the efficacy was evaluated according to the modified MacNab criteria,and the results were excellent in47cases and good in8cases.No case recurred during the follow-up period.Conclusion TLIF in double?incision under Quadrant channel in the treatment of lumbar degenerative disease has obvious curative effect.The recurrent rate is low.