Quadrant 通道下肌间隙入路微创经椎间孔椎间融合术治疗退变性腰椎滑脱症的临床效果

摘要

目的：探讨采用Quadrant通道下肌间隙入路微创经椎间孔椎间融合术治疗退变性腰椎滑脱症的临床效果。方法选取南京中医药大学附属张家港医院2009年5月至2011年12月行Quadrant通道下肌间隙入路微创经椎间孔椎间融合术治疗的23例退变性腰椎滑脱症患者，患者均给予Quadrant通道下肌间隙入路微创经椎间孔椎间融合术治疗。记录观察手术时间、术中出血量、住院时间、术后切口愈合情况、术后椎体复位情况、视觉模拟评分及临床疗效。结果本组23例均手术顺利，无中转开放手术。手术时间118～182 min，术中出血量155～304 ml，住院时间为8～17 d。术后切口均Ⅰ期愈合。术后X线片示滑脱椎体均复位满意。术后随访时间11～30个月，均已达到骨性融合。末次随访时视觉模拟评分与治疗前比较，差异有统计学意义[（1．1±0．9）分比（8．3±1．1）分，P＜0．01]。末次随访时按Nakai评定标准：优20例，良3例，优良率为100．0％。 CT重建显示椎间融合器内有连续骨小梁通过。结论采用Quadrant通道下肌间隙入路微创经椎间孔椎间融合术是一种微创治疗退变性腰椎滑脱症可行方法。%Objective To evaluate the effects of minimal transforaminal lumbar interbody fusion ( Mini-TLIF ) via quadrant invasive system for the treatment of degenerative lumbar spondylolisthesis . Methods Totally 23 cases from Zhangjiagang Hospital Affiliated to Nanjing University of Chinese Medicine , from May 2009 to December 2011 were selected;all patients were given minimal transforaminal lumbar interbody fusion via quadrant invasive system .Time of operation , intraoperative blood loss , length of stay , postoperative incision healing, postoperative vertebral reset , Visual Analogue Scale and clinical effects of the patients were recorded and observed .Results The operations were performed smoothly for all the patients without further complications .The average operating time was 118-182 minutes and the average amount of blood loss was 155-304 ml.The average hospital stay time was 8-17 days.The healed wound was classified as grade A .Postoperative X-rays showed slipped vertebrae reduction.The mean follow-up duration was approximately 11 to 30 months.The VAS of lower back pain decreased from (8.3 ±1.1) preoperation to (1.1 ±0.9) at the last follow up postoperation (P <0.01). According to Nakai standard , the results were excellent in 20 cases and good in 3 cases at the last follow up .Upon evaluations of the CT scan , reconstruction showed no failure of the internal fixation .Conclusion Mini-PLIF treat-ment via quadrant invasive system is a safe , effective, and minimally invasive surgical technique in treating degen-erative lumbar spondylolisthesis .