| 曹德军,张友树,张耀,等.可扩张管微创系统下行椎间孔腰椎椎间融合联合经皮椎弓根螺钉治疗腰椎滑脱 25例[J].安徽医药,2019,23(10):2014-2017. |
| 可扩张管微创系统下行椎间孔腰椎椎间融合联合经皮椎弓根螺钉治疗腰椎滑脱 25例 |
| The Quadrant System?assisted transforaminal lumbar interbody fusion combined with percutaneous pedicle screw fixation for treatment of lumbar spondylolisthesis:a study of 25 cases |
| |
| DOI：10.3969/j.issn.1009?6469.2019.10.027 |
| 中文关键词: 脊椎滑脱 脊柱融合术 腰椎 可扩张管微创系统 椎旁肌间隙 经皮椎弓根螺钉 |
| 英文关键词: Spondylolysis Spinal fusion Lumbar vertebrae Quadrant system Wiltse space Percutaneous pedicle screw fixation |
| 基金项目:四川省资阳市科技支撑计划( Zykjjsc20?2016?12) |
|
| 摘要点击次数: 2021 |
| 全文下载次数: 593 |
| 中文摘要: |
| 目的探讨可扩张管微创系统通道( Quadrant通道)下椎间孔腰椎椎间融合( TLIF)联合经皮椎弓根螺钉治疗 Ⅰ~Ⅱ度腰椎滑脱临床疗效。方法回顾分析 2012年 9月至 2017年 4月间资阳市第一人民医院收治的 58例单节段 Ⅰ~Ⅱ度腰椎滑脱症， 25例在可扩张 Quadrant通道下行椎管减压、经皮椎弓根螺钉复位、椎间植骨融合术( MIS?TLIF)33例行传统后路开放手术(OPEN?TLIF)。两组病人性别、年龄、病史、术前滑脱程度、 VAS、JOA评分等一般资料均差异无统计学，意义( P＞0.05)具有可比性。记录两组术中出血量、术后引流量、手术时间、术中透视次数、术后下地时间、术前、术后视觉模拟评分法( VAS)，评分、 Oswestry功能障碍指数( ODI)评分、滑脱移位程度、滑脱复位率及术中术后并发症。结果术中、术后无神经根损伤、伤口感染、脑脊液漏等并发症。两组病人均获随访 13～19月，平均随访 14.3月。 MIS?TLIF较 OPEN?TLIF术中出血量少［(230.0±75.2) mL比( 350.0±98.7)mL］、术后引流量少［(125.3±29.5)mL比( 210.0±39.4)mL］、术后下地时间短［(2.1±0.7)d比( 8.3±0.9)d］、手术时间长［( 154.3±31.5)min比( 107.0±30.5)min］术中射线透视次数多［( 18.1±2.3)比( 5.4±1.2)］均差异有统计学意义( P＜ 0.05)。两组术后 VAS、ODI评分较术前低( P＜0)。 MIS?TLIF较 OPEN?TLIF术后 1d、3d、2周、 VAS评分及术后 2周、 3月 ODI评分低，两组间差异有统计学意义( P＜0.05)。两组术后 2周、末次访问的滑脱率均低于术前( P＜0.05)。两组间术后 2周、末次访问的滑脱率差异无统计学意义( P＞0.05)。 MIS?TLIF在术中出血量、术后引流量、下地时间及术后出血、缓解短中期疼痛方面更具有优势，而在手术时间、术中透视次数方面劣于 OPEN?TLIF。结论经扩张 Quadrant通道下 TLIF联合经皮椎弓根.05，3月，螺钉治疗腰椎滑脱具有出血少，术后疼痛轻，功能恢复快，但需接受较多射线照射，手术时间较长。 |
| 英文摘要: |
| Objective To explore the efficacy of Quadrant System ? assisted transforaminal lumbar interbody fusion combinedwith percutaneous pedicle screw fixation in the treatment of lumbar spondylolisthesis.Methods In this study 58 cases of lumbar spondylolisthesis were retrospectively analyzed，who were hospitalized in The First People’s Hospital of Ziyang and 25 of them were treated with Quadrant System?assisted spinal canal decompression，percutaneous pedicle screw fixation and transforaminal lum? bar interbody fusion(MIS?TLIF)while the other 33 were treated with conventional open surgery(OPEN?TLIF).There were no dif? ferences in gender，age，medical history，pre?surgical degree of slip，visual analogue score(VAS)，and the Japanese Orthopedic As? sociation(JOA)score.The intraoperative bleeding，postoperative drainage，operation time，times of X?ray test，time of leaving bed， preoperative and postoperative VAS scores，Oswestry Disability Index(ODI)score，slip degree，reduction rate of slip，and intraoper? ative and postoperative complications were recorded and compared between two groups.Results There were no intraoperative or postoperative nerve root injury，wound infection，cerebrospinal fluid leakage and other complications.Both groups were followed up for 13?19 months，with a median of 14.3 months.MIS?TLIF was more effective than OPEN?TLIF in intraoperative bleeding［(230.0± 75.2)mL vs.(350.0±98.7)mL］，postoperative drainage volume［( 125.3±29.5)mL vs.(210.0±39.4)mL］，time to leave bed［( 2.1± 0.7)d vs.(8.3±0.9)d］，operation time［(154.3±31.5)min vs.(107.0±30.5)min］，and intraoperative number of X?ray test［( 18.1± 2.3)vs.(5.4±1.2)］ with significant difference(P＜0.05).Postoperative VAS and ODI scores were lower than preoperative VAS and ODI scores in both groups(P＜0.05).There were statistically significant differences in VAS score between the two groups at 1， 3 days，2 weeks，three months of postoperation and in ODI score 2 weeks and 3 months of postoperation(P＜0.05).The postopera?tive slip rates of both groups 2 weeks after surgery and during the last follow?up were lower than preoperative rates(P＜0.05). There were no statistically significant differences in slip rate between the two groups(P＞0.05).MIS?TLIF is superior to OPEN? TLIFin intraoperative blood loss，postoperative drainage volume，postoperative time to leave bed，postoperative blood loss and short? to medium?term pain relief，but inferior to OPEN?TLIF in operating time and times of intraoperative X?ray test.Conclusion Quad?rant System?assisted transforaminal lumbar interbody fusion combined with percutaneous pedicle screw fixation has the advantagesof less blood loss，less postoperative pain，fast recovery.The deficiencies are more radiation and longer operating time. |
|
查看全文
查看/发表评论 下载PDF阅读器 |
| 关闭 |
