通道下单侧椎体间减压融合内固定结合对侧经皮椎弓根螺钉内固定治疗腰椎退变性疾病

摘要

目的：探讨采用 Quadrant通道下单侧椎体间减压融合内固定结合对侧经皮椎弓根螺钉内固定治疗腰椎退变性疾病的方法及疗效。方法2009年9月至2012年12月，采用Quadrant通道下单侧PLIF技术结合对侧经皮椎弓根螺钉内固定微创治疗腰椎退变性疾病共20例，男8例，女12例；年龄45~66岁，平均57.5岁。病程1~8年，平均36.5个月。腰椎间盘突出症11例，复发性腰椎间盘突出症4例，腰椎间盘突出合并1°退变性滑脱症3例，腰椎间盘突出合并腰椎不稳症2例。术前患者腰痛视觉模拟疼痛评分（ visual analogue scale，VAS）为（6.5±1.1）分。结果患者手术时间（150±20）min，术中出血量（340±90）mL，术后住院时间为（11.0±3.5）d。术后切口均Ⅰ期愈合。患者均获随访，随访时间6~20个月，平均15.2个月。末次随访时VAS评分为（1.4±2.2）分，与术前比较差异有统计学意义（ P﹤0.05）。X线片示术后6个月椎体间达骨性融合，未见椎弓根螺钉内固定系统松动、断裂或移位。末次随访时临床疗效按改良Macnab标准评定，获优18例，良2例。结论对于单节段病变，且只需要单侧操作即可完成减压和椎间融合者，Quadrant通道下单侧椎体间融合内固定结合对侧经皮椎弓根螺钉内固定是一种可供临床选择的微创手术方式。%Objective To evaluate the safety and effectiveness of unilateral interbody decompression fusion and internal fixation combined with contralateral percutaneous pedicle screw fixation through the Quadrant channel in the treatment of lumbar degenerative disc disease.Methods 20 patients were enrolled between September 2009 and December 2012. There were 12 females and 8 males. Their mean age was 57. 5(range 45 ~66),with the mean duration of 36. 5(range 24 ~96)months. Among these patients,there were 11 cases of lumbar disc herniation,4 cases of recurrent lumbar disc herniation,3 cases of lumbar disc herniation conbined with degenerative spondylolisthesis(degree I)and 2 cases of lumbar disc herniation conbined with instability. The average lumbar pain Visual Analog Scale(VAS)before surgery was(6. 5 ±1. 1). Results The average operative time wa(s 150 ±20)min. Mean blood loss during operation wa(s 340 ±90)mL. Postoperative hospital stay averaged (11. 0 ±3. 5)d. The incision were healed in stage I. At last follow-up,all patients were available for evaluation,and mean follow- up was 15. 2(range 6 ~20)months. Mean VAS was(1. 4 ±2. 2)at the final follow-up,which was significantly improved as compared to preoperation(P ﹤0. 05). At the 6 month follow-up,interbody bony fusion was investigated,and no cases of pedicle screw loosening,fracture or displacement was detected as shown by X-ray. According to Modified Macnab scale,18 patients had excellent outcomes,and 2 had good outcomes. Conclusion Unilateral interbody decompression fusion and internal fixation combined with contralateral percutaneous pedicle screw fixation through the Quadrant channel is a minimally invasive surgery which is available for clinical choice for patients with single segmental lesions and need only a unilateral operation to complete decompression and interbody fusion.