【摘要】 目的探讨应用Quadrant可扩张器械微创经椎间孔腰椎椎间融合术(TLIF)治疗退变性腰椎管狭窄症的效果。方法 69例退变性腰椎管狭窄症病人,均在Quadrant扩张器械下行微创TLIF,记录手术时间、术中出血量、住院时间。采用疼痛视觉模拟评分(VAS评分)、Oswestry功能障碍评分(ODI评分)及改良MacNab法评价临床疗效。结果单节段狭窄者手术时间80～150min,平均98min,术中出血量50～300mL,平均176mL;双节段狭窄者手术时间110～200min,平均154min,术中出血量100～500mL,平均240mL。住院时间7～12d,平均9d。术前、术后1周及末次随访VAS评分分别为7.9±2.8、3.4±2.5、1.7±2.5,ODI评分分别为30.8±5.5、21.7±3.4、9.4±6.3,两种评分术后1周与术前比较、末次随访与术后1周比较差异均有显著性(t=5.41～11.46,P<0.05)。末次随访临床疗效优41例,良11例,可6例。末次随访椎间融合率为91.4%(53/58)。结论 Quadrant扩张器械下行微创TLIF治疗退变性腰椎管狭窄症具有创伤小、术中出血量少、术后无需引流、恢复快、住院时间短、疗效确切等优点,是治疗退行性腰椎管狭窄症的良好方法。更多还原

【Abstract】 Objective To explore the clinical effect of minimally invasive transforaminal lumbar interbody fusion(TLIF) done under Quadrant dilator for degenerative lumbar stenosis(DLS).Methods Sixty-nine patients with DLS were treated with TLIF under Quadrant dilator.The operation time,intraoperative blood loss,and hospital stay were recorded.The clinical efficacy was assessed by VAS score,ODI score and modified MacNab criteria.Results The operation time(mean) was 80-150 min(98 min),blood loss(mean) was 50-300 mL(176 mL) for one-segment stricture;the operation time(mean) of two-segment stricture was 110-200 min(154 min) and blood loss(mean) was 100-500 mL(240 mL).Hospital stay was(mean) 7-12 days(9 days).VAS scores before surgery,one week after surgery and at the last follow-up were 7.9±2.8,3.4±2.5,and 1.7±2.5,respectively;and ODI scores were 30.8±5.5,21.7±3.4,and 9.4±6.3,respectively.A comparison,between before surgery and one week after,and between one week after surgery and the last follow-up,showed significantly different in both two scoring methods(t=5.41-11.46,P<0.05).At the last follow-up,41 cases were excellent,11 were good,and six were general.The fusion rate at final follow-up was 91.4%.Conclusion Minimally invasive TLIF under Quadrant dilator is a good method in the treatment of DLS,which has advantages of safety,less tissue trauma and blood loss at surgery,no postoperative drainage is needed,rapid recoveryand short hospital stay.更多还原