Quadrant通道辅助下微创经椎间孔减压腰椎融合固定术治疗单节段性腰椎病变的疗效研究

发布时间：2018-10-05 12:52

【摘要】：目的探讨Quadrant通道辅助下微创经椎间孔减压腰椎融合固定术治疗单节段性腰椎病变的疗效。方法选择76例经保守治疗但情况未见好转的单一节段腰椎退变性疾病的患者进行前瞻性研究,将全部研究对象分为观察组和对照组,各38例。其中对照组行传统开放手术,观察组行Quadrant通道辅助下微创经椎间孔减压腰椎融合固定术。术后对两组患者进行为期2~3年的随访,平均随访时间(2.5±0.72)年,对患者的临床资料以及术后恢复情况进行分析和对比。结果 (1)两组患者术中手术时间、并发症、术后6个月、24个月融合率均差异无统计学意义(P=0.853,P=0.152,P=0.713,P=0.602);观察组患者中术中出血量、术后引流量相较于对照组有显著降低,且术后住院时间明显比对照组短,差异有统计学意义(均P0.001);(2)两组患者术后1个月、24个月时的腰痛、腿痛VAS评分以及Oswestry功能障碍指数(Oswestry dysfunction index,ODI)均比术前有了明显下降,差异有统计学意义(均P0.05),且呈逐渐降低趋势;观察组患者术后1个月腰痛、腿痛VAS评分均显著低于对照组(P0.001,P=0.008);两组患者术后24个月腰痛、腿痛VAS评分以及术后1个月、24个月ODI差异无统计学意义(P=0.279,P=0.442,P=0.890,P=0.854);(3)两组患者术后肌酸磷酸激酶(CPK)较术前有了明显升高,且在术后1 d达到最高峰值,在术后7 d基本恢复正常,且观察组患者术后1、3 d的CPK明显低于对照组(均P0.001),但两组患者术后5、7 d CPK差异无统计学意义(P=0.883,P=0.678);观察组患者术后3个月MRI测T2弛豫时间明显比对照组短,差异有统计学意义(P0.001)。结论 Quadrant通道辅助下经椎间孔减压腰椎融合固定术的近期疗效与传统后路开放术一致,且具有肌肉、软组织损伤小以及早期功能恢复更加良好等优势。
[Abstract]:Objective to evaluate the effect of Quadrant channel assisted minimally invasive decompression and lumbar fusion fixation through intervertebral foramen in the treatment of single segment lumbar disease. Methods A prospective study was conducted in 76 patients with single segment lumbar degenerative disease who were treated conservatively but the condition was not improved. All the subjects were divided into observation group and control group with 38 cases each. The control group received traditional open surgery and the observation group received minimally invasive intervertebral foramen decompression and lumbar fusion fixation assisted by Quadrant channel. Two groups of patients were followed up for 2 ~ 3 years, the average follow-up time was (2.5 卤0.72) years. The clinical data and postoperative recovery were analyzed and compared. Results (1) there was no significant difference in intraoperative time, complications, fusion rate at 6 months and 24 months after operation between the two groups (P < 0. 853), and the amount of intraoperative blood loss and postoperative drainage in the observation group were significantly lower than those in the control group (P < 0. 853). The postoperative hospitalization time was significantly shorter than that in the control group (P0.001); (2). The VAS scores of low back pain, leg pain and Oswestry dysfunction index (Oswestry dysfunction index,ODI) in the two groups were significantly lower than those before operation at 1 month and 24 months after operation (all P0. 001); (2). The difference was statistically significant (P0.05) and decreased gradually. The VAS scores of low back pain and leg pain in the observation group were significantly lower than those in the control group (P0.001, P0. 008), the patients in the two groups had low back pain 24 months after operation, and the scores of LBP in the observation group were significantly lower than those in the control group. There was no significant difference in VAS score of leg pain and ODI at 1 month and 24 months after operation (P < 0. 279). Creatine phosphokinase (CPK) in the two groups was significantly higher than that before operation (P < 0. 279), and reached the peak value on the 1st day after operation and returned to normal on the 7th day after operation. The CPK of the observation group was significantly lower than that of the control group on the 3rd day after operation (P0. 001), but there was no significant difference in CPK between the two groups on the 7th day after operation (P0. 883 P0. 678), and the T 2 relaxation time measured by MRI 3 months after operation in the observation group was significantly shorter than that in the control group (P0. 001). Conclusion the short-term curative effect of Quadrant channel assisted intervertebral foramen decompression and lumbar fusion fixation is consistent with that of the traditional posterior approach, and it has the advantages of less soft tissue injury and better early functional recovery.
【作者单位】：西安医学院第一附属医院骨科;
【分类号】：R687.3

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