Quadrant通道下改良微创TLIF术在腰椎间盘突出症中的应用研究

Application of Modified Minimally Invasive TLIF under Quadrant Channel in Lumbar Disc Herniation

目的探讨Quadrant通道下改良微创椎间孔椎间融合术(TLIF)在腰椎间盘突出症中的应用价值。方法选取2017年5月-2018年5月本院收治的82例腰椎间盘突出症患者为研究对象,均接受Quadrant通道下改良微创TLIF术治疗,观察本组患者术前后疼痛视觉模拟评分(VAS)、Oswestry功能障碍指数(ODI)及并发症发生情况,并于术后3、12个月采用改良Macnab标准评估患者手术疗效。结果 82例腰椎间盘突出症患者均成功完成Quadrant通道下改良微创TLIF术治疗,手术时间为(85.70±11.03)min,切口长度(2.80±0.34)cm,术中出血量(170.39±26.99)ml,术后下地活动时间(2.50±0.24)d,术后随访时间2~12(6.98±1.08)个月。本组患者术后2、8、12个月ODI评分、VAS评分较术前明显降低,组内不同时点的ODI评分、VAS评分比较差异有统计学意义(P<0.05);本组患者术后12个月治疗优良率明显高于术后3个月,且术后12个月手术疗效分级明显优于术后3个月(P<0.05)。82例患者未出现明显的神经根损伤以及椎间隙感染等并发症,发生切口浅表感染、切口皮下脂肪液化等并发症,但经保守治疗后都好转。结论 Quadrant通道下改良微创TLIF术在腰椎间盘突出症患者治疗中效果明显,能够优化手术相关指标,有效缓解术后疼痛,有利于功能恢复,且手术安全性好。

Objective To investigate the application value of modified minimally invasive transformational lumbar interbody fusion(TLIF) under Quadrant channel in lumbar disc herniation. Methods A total of 82 lumbar disc herniation patients who were admitted to our hospital from May 2017 to May 2018 were enrolled. All patients underwent modified minimally invasive TLIF under Quadrant channel. The changes in score of visual analogue scale(VAS) and Oswestry disability index(ODI) before and after surgery, and occurrence of complications were observed. At 3 and 12 months after surgery, modified Macnab criteria were performed to assess curative effect of surgery. Results All 82 lumbar disc herniation patients underwent modified minimally invasive TLIF under Quadrant channel successfully. The duration of operation, incision length, intraoperative blood loss, postoperative activity time on the ground, duration of postoperative follow-up and duration of follow-up were(85.70±11.03) min, 2.80±0.34 cm,(170.39±26.99) ml,(2.50±0.24) d and 2-12(6.98±1.08) months respectively. At 2, 8 and 12 months after surgery, ODI score and VAS score were significantly decreased. There were significant difference in ODI score and VAS score at different time points within the same group(P<0.05). At 12 months after surgery, good rate was significantly higher than that at 3 months after surgery. The grading of curative effect of surgical treatment at 12 months after surgery was significantly better than that at 3 months after surgery(P<0.05). Of the 82 cases in this group, there was no obvious nerve root injury or complications such as intervertebral space infection. The complications such as superficial wound infection and subcutaneous fat liquefaction in incision were improved after conservative treatment. Conclusion The curative effect of modified minimally invasive TLIF under Quadrant channel is significant on lumbar disc herniation patients. It can optimize surgical related indexes, effectively relieve postoperative pain, and facilitate functional recovery. In addition, surgical safety is relatively good.