Quadrant通道下改良经椎间孔腰椎椎体融合术治疗腰椎间盘突出症伴节段不稳

目的 比较Quadrant通道下与非通道下行改良经椎间孔腰椎椎体间融合术（TLIF）治疗腰椎间盘突出症伴节段不稳的临床效果.方法 65例腰椎间盘突出症伴节段不稳患者中,21例采用Quadrant通道下改良TLIF（通道组）,44例采用非通道改良TLIF（对照组）,比较两组的术中出血量、术后引流量、手术时间、住院时间、手术前及末次随访时腰痛视觉模拟评分（VAS）、JOA评分及改善率.结果 65例均获随访,时间6～12个月,末次随访时两组VAS和JOA评分较术前均明显改善,差异有统计学意义（P＜0.05）,通道组在术中出血量、术后引流量、住院时间、末次随访时VAS评分、JOA评分及改善率等方面均优于对照组,差异有统计学意义（P＜0.05）.结论 Quadrant通道下与非通道下改良TLIF治疗腰椎间盘突出症伴节段不稳均可取得较好的临床疗效,前者具有椎旁肌损伤小、出血少、住院时间短、术后腰痛发生率低、恢复快等优点.

Modified transforaminal lumbar interbody fusion via MAST Quadrant retractor for lumbar disc herniation with segmental instability

Objective To compare clinical outcomes of modified transforalninal lumbar interbody fusion （TLIF） with or without MAST Quadrant retractor for lumbar disc herniation with seglnental instability. Methods 65 cases suf feted from lumbar disc herniation with seglnental instability, in which 21 eases were treated by modified TLIF via MAST Quadrant retractor（MAST Quadrant retractor group） ,44 cases were operated without MAST Quadrant retractor （compare group）. The blood loss during operation, postoperative drainage, operation time, hospital day, visual ana logue scores（VAS） and Japanese Orthopaedic Association （JOA） scores before operation and the last follow up, iln provement rate of JOA between two groups were compared. Results All cases were followed up from 6 to 12 months. The VAS were lower and JOA scores were higher at last follow up than preoperative ones in two groups, the difference was significant （P 〈 0. 05）. The MAST Quadrant retractor group had less blood loss during operation, less postopera-rive drainage, shorter operation time, shorter hospital day, lower VAS, higher JOA scores and improvement rate than the compared group, the difference was significant （P 〈 0. 05 ）. Conclusions Modified TLIF with or without MAST Quadrant retractor for lumbar disc herniation with segmental instability both can achieve a good efficiency, the former has the advantages of less paraspinal muscle damage and blood loss, shorter hospitalization time, less postoperative lumbar pain, faster postoperative recovery.