Quadrant通道下微创TLIF治疗复发性腰椎间盘突出症的临床研究.docVIP

Quadrant通道下微创TLIF治疗复发性腰椎间盘突出症的临床研究 康辉，蔡贤华，徐峰，黄勇 （广州军区武汉总医院骨科 武汉 430070） 【摘要】目的：探讨Quadrant通道下微创TLIF术治疗复发性腰椎间盘突出症的临床疗效。方法：2005年2月～2010年3月收治复发性腰椎间盘突出症患者35例。其中男22例，女13例；年龄33～62岁，平均53.2岁；L4/518例，L5S113例，L4/5和L5S1双节段4例。复发时间为首次手术后8～70个月，平均38.2个月。35例患者均经肌间隙在Quadrant可扩张管道系统下行微创TLIF手术。采用视觉模拟评分系统（VAS）评估患者术前、术后3天、术后一年的疼痛情况；采用腰椎JOA（29分法）功能评分对患者手术前、术后一年的腰椎功能进行评估、并计算改善率。结果：所有病例均无脑脊液漏、无神经根损伤。随访时间19～41个月，平均20个月，所有患者植骨均融合、无椎弓根螺钉断裂、融合器移位。术前VAS评分为7.63±0.81分，术后3天VAS评分为2.46±0.92分，术后一年VAS评分为1.14±0.69分，VAS评分术后3天与术前比较、术后一年与术后3天比较有统计学差异(P﹤0.05)；术前JOA评分为14.26±1.36分，术后一年JOA评分为25.06±1.19分，JOA评分术后一年与术前比较有统计学差异(P0.05)。结论：经Quadrant通道微创TLIF术治疗复发性腰椎间盘突出症是安全、可行的。 【关键词】复发性腰椎间盘突出症；TLIF；Quadrant通道 Clinical research of minimally invasive TLIF under quadrant system in treatment of Recur- ent lumbar disc herniation / Kang Hui，Cai Xianhua，Xu Feng，et al.Objective：To analyze the effectiveness of minimally invasive TLIF under quadrant system in treatment of recurrent lumbar disc herniation. Method：From February 2005 to March 2010, a total of 35 cases with recurrent lumbar disc herniation underwent surgical intervention were retrospectively analyzed. There were 22 men and 13 women, with the mean age of 53.2years (from33 to 62 years).A total of 39 segments were involved, including L4/5 in 18cases, L5S1 in 13cases，L4/5 and L5S1 double segments in 4 cases. The time between first operation and recurrence was 8-70 months（mean, 38.2 months). 35 cases of recurrent lumbar disc herniation were treated with minimally invasive TLIF via bilateral muscle gap under MAST Quadrant retractor. VAS score system was used to evaluate back pain the pre- and post operative (3d and 12 months ). JOA (29) score system was used to evaluate the pre- and post operative (12 months ) score and improvement rate. Result: There were no leakage of cerebrospinal fluid and nerve root injury during the operation.. All patients were followed up for 19～ months (mean, 20 months). All patients got bone fusion and no internal fixation failure. VAS score