Quadrant 通道辅助下微创经椎间孔减压腰椎融合固定术治疗单节段性腰椎病变的疗效研究

摘要

目的：探讨 Quadrant 通道辅助下微创经椎间孔减压腰椎融合固定术治疗单节段性腰椎病变的疗效。方法选择76例经保守治疗但情况未见好转的单一节段腰椎退变性疾病的患者进行前瞻性研究，将全部研究对象分为观察组和对照组，各38例。其中对照组行传统开放手术，观察组行 Quadrant 通道辅助下微创经椎间孔减压腰椎融合固定术。术后对两组患者进行为期2～3年的随访，平均随访时间（2．5±0．72）年，对患者的临床资料以及术后恢复情况进行分析和对比。结果（1）两组患者术中手术时间、并发症、术后6个月、24个月融合率均差异无统计学意义（P ＝0．853，P ＝0．152，P ＝0．713，P ＝0．602）；观察组患者中术中出血量、术后引流量相较于对照组有显著降低，且术后住院时间明显比对照组短，差异有统计学意义（均 P ＜0．001）；（2）两组患者术后1个月、24个月时的腰痛、腿痛 VAS 评分以及 Oswestry 功能障碍指数（Oswestry dysfunction index， ODI）均比术前有了明显下降，差异有统计学意义（均 P ＜0．05），且呈逐渐降低趋势；观察组患者术后1个月腰痛、腿痛 VAS 评分均显著低于对照组（P ＜0．001，P ＝0．008）；两组患者术后24个月腰痛、腿痛 VAS 评分以及术后1个月、24个月 ODI 差异无统计学意义（P ＝0．279，P ＝0．442，P ＝0．890，P ＝0．854）；（3）两组患者术后肌酸磷酸激酶（CPK）较术前有了明显升高，且在术后1 d 达到最高峰值，在术后7 d 基本恢复正常，且观察组患者术后1、3 d 的 CPK 明显低于对照组（均 P ＜0．001），但两组患者术后5、7 d CPK 差异无统计学意义（P ＝0．883，P ＝0．678）；观察组患者术后3个月 MRI 测 T2弛豫时间明显比对照组短，差异有统计学意义（P ＜0．001）。结论Quadrant 通道辅助下经椎间孔减压腰椎融合固定术的近期疗效与传统后路开放术一致，且具有肌肉、软组织损伤小以及早期功能恢复更加良好等优势。%Objective To explore the effect of minimally invasive transforaminal lumbar interbody fusion assisted by Quadrant channel to cure single segment lumbar spine disease.Methods We selected 76 case of patients with single segment lumbar degenerative dis-ease,whose conditions were not improved after treated with conservative treatment.All the subjects were randomized into observation group and control group,with 38 cases in each group.The control group was treated with traditional open surgery,while the observation group was treated with minimally invasive transforaminal lumbar interbody fusion assisted by Quadrant channel.After operation,the pa-tients were followed up for 2 to 3 years.The average follow-up time was(2.5 ±0.72)years.The clinical data and postoperative recovery of the patients were analyzed and compared.Results (1)There were no significant differences in the operation time,complications,fu-sion rates 6 months and 24 months after surgery(P =0.853,P =0.152,P =0.713,P =0.602,respectively);Compared with the control group,the intraoperative blood loss,postoperative drainage volume in the observation group were significantly lower ,and the postopera-tive hospital stay was significantly shorter ,which indicated statistically significant differences(all P <0.001).(2)One month and 24 months after surgery,the back pain,leg pain VAS score and ODI(Oswestry dysfunction index)of two groups were obviously lower than before surgery,which indicated statistically significant differences(all P <0.05),and showed a gradual decreasing trend.One month af-ter surgery,the low back pain,leg pain VAS scores of the observation group were significantly lower than those of the control group(P <0.001,P =0.008).There were no significant differences in the back pain,leg pain VAS score 24 months after surgery and ODI 1 month and 24 months after surgery between the two group(P =0.279,P =0.442,P =0.890,P =0.854,respectively).(3)The postop-erative CPK of the two groups were significantly higher than those before operation,which reached the highest in 1 day after surgery,and returned to normal in 7 days after surgery.The CPK in 1 day and 3 days after surgery in the observation group were significantly lower than those in the control group,which indicated statistically significant difference(both P <0.001),but there was no significant differ-ence in CPK 5 days and 7 days after surgery(P =0.883,P =0.678).Three months after operation,MRI relaxation time of T2 measure-ment in the observation group was significantly shorter than that in the control group(P <0.001).Conclusion The recent curative effect of minimally invasive transforaminal lumbar interbody fusion assisted by Quadrant channel was consistent with traditional posterior approach,which had the advantages of less muscle,soft tissue injury and better early functional recovery.