填塞自体骨粒的Concorde脊柱微创椎间融合器经椎间孔椎体间融合治疗脱垂游离型腰椎间盘突出症

摘要

BACKGROUND:As one of the most serious pathological types of lumbar disc herniation, the nucleus pulposus of prolapsed style lumbar intervertebral disc herniation is like a cord or mass. And the nucleus pulposus compresses nerve roots and dural sac, which brings severe low back pain and/or cauda equina injury symptoms.OBJECTIVE:To compare the clinical efficacy of simple discectomy under the Quadrant system and minimally invasive transforaminal lumbar interbody Concorde fusion (MIS-TLIF) in the treatment of prolapsed and sequestrated lumbar disc herniation.METHODS:From January 2012 to January 2015, 58 patients with prolapsed and sequestrated lumbar disc herniation were enrolled in this study, including 36 patients in simple Quadrant group and 22 patients in MIS-TLIF group.RESULTS AND CONCLUSION:Significant difference was recorded in the visual analogue scale scores and Oswestry disability index at 1 week, 3 months and 18 months postoperation compared with preoperation in the two groups (P < 0.05). Compared with the simple Quadrant group, the visual analogue scale scores of low back pain and Oswestry disability index were significantly decreased in the MIS-TLIF group at postoperative 18 months (P < 0.05), but there was no significant difference in the visual analogue scale score of leg pain between two groups (P > 0.05). There were two patients with recurrent lumbar disc herniation in the simple Quadrant group. In summary, simple discectomy under the Quadrant system could achieve the similar satisfied effect as the MIS-TLIF, but the MIS-TLIF provides less low back pain.%背景:脱垂游离型腰椎间盘突出症中突出游离于椎管内的髓核呈条索状、团块状,压迫神经根和硬膜囊,造成机体出现严重的腰腿痛和/或马尾神经损伤症状.目的:比较通道下单纯髓核摘除与通道辅助下微创经椎间孔椎体间融合并自体骨粒填塞治疗脱垂游离型腰椎间盘突出症的临床效果.方法:一项在2012年1月至2014年1月进行的回顾性研究,将收集脱垂游离型椎间盘突出症经保守治疗无效的58例患者,按照治疗方法分为通道下单纯髓核摘除组(n=36,仅进行单纯髓核摘除)和微创经椎间孔椎体间融合并自体骨粒填塞组(n=22,Concorde脊柱微创椎间融合器进行植骨融合,合并自体骨粒填塞).结果与结论:2组患者术后1周、3个月及18个月时目测类比评分和Oswestry功能障碍指数均比术前明显下降(P<0.05).微创经椎间孔椎体间融合组术后18个月腰痛目测类比评分和Oswestry功能障碍指数低于通道下单纯髓核摘除组(P<0.05).2组腿痛目测类比评分接近(P>0.05).通道下单纯髓核摘除组有2例术后复发.结果提示通道下单纯髓核摘除和微创经椎间孔椎体间融合并自体骨粒填塞治疗脱垂游离型腰椎间盘突出症均可取得满意的临床疗效,且微创经椎间孔椎体间融合并自体骨粒填塞在腰痛缓解方面更具有优势.