Med、Quadrant、Sextant-R系统联合微创治疗腰椎滑脱症的临床研究.docVIP

MED、Quadrant、Sextant-R系统联合微创治疗腰椎滑脱症的临床研究 康辉 蔡贤华 徐峰 黄勇 作者单位：广州军区武汉总医院骨科（湖北武汉 430070） 康辉，主治医师，研究方向：脊柱外科，E-mail：kanghuicss@163.com【摘要】 目的 探讨MED系统、Quadrant系统联合Sextant-R系统微创治疗腰椎滑脱症的临床疗效。方法 本组共收治腰椎滑脱症35例，其中峡部裂型腰椎滑脱症11例、退变性腰椎滑脱症24例；年龄33～71岁，平均55岁；男性25例、女性10例；腰4/5滑脱21例、腰5骶1滑脱14例。根据Meyerding分级，均为Ⅰ度滑脱。均采用椎旁肌间隙入路，症状重的一侧在Quadrant可扩张管道系统下进行减压、植骨、融合，症状轻或无症状的一侧在MED系统下行椎板间开窗减压，通过Sextant-R系统进行置钉、滑脱提拉复位。术前、术后一年采用视觉模拟评分系统（VAS）评估患者疼痛情况；采用ODI(Oswestry disability index)评分法进行临床疗效评估。通过影像学测量术前、术后一年的滑脱率、椎间高度评估滑脱矫正情况。结果 所有病例术中均无脑脊液漏、无神经根损伤。随访时间18～38个月，平均26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（7.34±0.76）分，术后一年VAS评分为（1.09±0.61）分；ODI评分术前平均（37.80±2.11）分，术后一年平均为（8.09±1.07）分。VAS评分和ODI评分术前与术后一年比较有统计学差异(P﹤0.001)。所有患者滑脱均有一定程度的矫正，滑脱率由术前（19.86±3.90）%恢复到术后一年（3.83±2.06）%；椎间高度由术前（5.29±1.15）mm恢复到术后(10.09±1.12)mm。结论 把握好手术适应证，Med系统、Quadrant系统联合Sextant-R系统微创治疗腰椎滑脱症是安全、有效、可行的。 【关键词】腰椎 微创 滑脱 MED系统 Quadrant系统 Sextant-R系统 CLINICAL RESEARCH OF MINIMALLY INVASIVE SURGICAL MANAGEMENT FOR LUMBAR SPONDYLOLISTHESIS VIA MED SYSTEM, QUADRANT SYSTEM ASSISTED SEXTANT-R SYSTEM. //Kang Hui，Cai Xianhua，Xu Feng，. Department of Orthopaedics, Wuhan General Hospital of Guangzhou Command of PLA, Wuhan 430070,. 【Abstract】 Objective To analyze the effectiveness of minimally invasive surgical management for lumbar spondylolisthesis via Med system, Quadrant system assisted Sextant-R system. Methods The clinic data of 35 patients with lumbar spondylolisthesis were reviewed and analyzed, included isthmic spondylolisthesis(n=11) and degenerative spondylolisthesis(n=24). There were 25men and 10 women, with the mean age of 55 years (from33 to 71 years). Spondylolisthesis occurred at the L4/5 in 21 patients and at the L5S1 in 14 patients．According to Meyerding classification, 35 cases were of GradeⅠ. The surgeries performed minimally invasive via Quadrant system by muscle gap for decompression and fusion at the symptoms heavy side, via MED system for windowing of lamina for lumbar at mild symptoms or asymptomatic side, via