双侧经微创通道椎弓根置钉腰椎体间融合术治疗中央型腰椎间盘突出症

摘要

目的：探讨双侧经Quadrant微创通道椎弓根置钉联合单枚cage 经椎间孔入路腰椎体间融合术治疗中央型腰椎间盘突出症的疗效。方法将40例腰椎间盘突出症中央型患者根据手术方法分为Quadrant微创通道组（微创组，n＝20）和传统开放组（开放组，n＝20）。观察手术时间、术中出血量、切口长度、术后功能恢复及并发症情况。应用视觉模拟评分系统（ VAS）评定患者术前和术后6、12个月的疼痛程度；采用Oswestry 功能障碍指数（ ODI）判定症状改善程度。结果患者均获得12个月随访。无脑脊液漏、神经根损伤、伤口感染、伤口延迟愈合、椎弓根钉松动、断裂等并发症出现。微创组的手术时间长于开放组（P＜0.05），术中出血量与切口长度少（小）于开放组（P＜0.05）。两组术后6、12个月VAS评分及ODI评分与术前1 d比较均明显下降（P＜0.05）；术后6、12个月ODI评分两组比较差异有统计学意义（P＜0.05）；术后6、12个月VAS评分两组比较差异无统计学意义（ P＞0.05）。结论双侧经Quadrant微创通道椎弓根置钉联合单枚cage 经椎间孔入路腰椎体间融合术是治疗腰椎间盘突出症中央型及有双侧根性疼痛患者值得选择的术式。%Objective To investigate the effect of the treatment of central type lumbar disc herniation by the combi -nation of Shiumi Ne and single cage via the Quadrant .Methods Fourty patients with lumbar disc herniation were di-vided into Quadrant group (minimally invasive group, n=20) and traditional open group (open group, n=20).The operation time, bleeding volume, incision length, postoperative functional recovery and complications were observed . The degree of pain was assessed by using the visual analog scale ( VAS) before and 6,12 months after operation .The improvement of symptoms was determined by Oswestry disability index ( ODI ) .Results All the patients were fol-lowed up for 12 months, no cerebrospinal fluid leakage , nerve root injury , wound infection , wound delayed healing , pedicle screw loosening , fracture and other complications occurred .The operation time of the minimally invasive group was longer than that of the open group (P<0.05), the volume of bleeding and the length of the incision was less(smaller) in the open group (P<0.05).After 6 months and 12 months of the operation, the VAS and ODI of the two groups were significantly decreased compared with 1 day before operation (P<0.05).After 6 months and 12 months of the operation , there was a significant difference in ODI between the two groups ( P <0.05 ) .After 6 months and 12 months of the operation , there was not a significant difference in VAS between the two groups ( P>0.05).Conclusions Bilateral minimally invasive channel Shiumi Ne Quadrant combined with single cage through the intervertebral foramen into the lumbar interbody fusion is the treatment of lumbar disc herniation of the central type and bilateral root pain patients , which deserve to be selected .