發(fā)布時(shí)間：2018-10-05 12:52

【摘要】：目的探討Quadrant通道輔助下微創(chuàng)經(jīng)椎間孔減壓腰椎融合固定術(shù)治療單節(jié)段性腰椎病變的療效。方法選擇76例經(jīng)保守治療但情況未見好轉(zhuǎn)的單一節(jié)段腰椎退變性疾病的患者進(jìn)行前瞻性研究,將全部研究對(duì)象分為觀察組和對(duì)照組,各38例。其中對(duì)照組行傳統(tǒng)開放手術(shù),觀察組行Quadrant通道輔助下微創(chuàng)經(jīng)椎間孔減壓腰椎融合固定術(shù)。術(shù)后對(duì)兩組患者進(jìn)行為期2~3年的隨訪,平均隨訪時(shí)間(2.5±0.72)年,對(duì)患者的臨床資料以及術(shù)后恢復(fù)情況進(jìn)行分析和對(duì)比。結(jié)果 (1)兩組患者術(shù)中手術(shù)時(shí)間、并發(fā)癥、術(shù)后6個(gè)月、24個(gè)月融合率均差異無(wú)統(tǒng)計(jì)學(xué)意義(P=0.853,P=0.152,P=0.713,P=0.602);觀察組患者中術(shù)中出血量、術(shù)后引流量相較于對(duì)照組有顯著降低,且術(shù)后住院時(shí)間明顯比對(duì)照組短,差異有統(tǒng)計(jì)學(xué)意義(均P0.001);(2)兩組患者術(shù)后1個(gè)月、24個(gè)月時(shí)的腰痛、腿痛VAS評(píng)分以及Oswestry功能障礙指數(shù)(Oswestry dysfunction index,ODI)均比術(shù)前有了明顯下降,差異有統(tǒng)計(jì)學(xué)意義(均P0.05),且呈逐漸降低趨勢(shì);觀察組患者術(shù)后1個(gè)月腰痛、腿痛VAS評(píng)分均顯著低于對(duì)照組(P0.001,P=0.008);兩組患者術(shù)后24個(gè)月腰痛、腿痛VAS評(píng)分以及術(shù)后1個(gè)月、24個(gè)月ODI差異無(wú)統(tǒng)計(jì)學(xué)意義(P=0.279,P=0.442,P=0.890,P=0.854);(3)兩組患者術(shù)后肌酸磷酸激酶(CPK)較術(shù)前有了明顯升高,且在術(shù)后1 d達(dá)到最高峰值,在術(shù)后7 d基本恢復(fù)正常,且觀察組患者術(shù)后1、3 d的CPK明顯低于對(duì)照組(均P0.001),但兩組患者術(shù)后5、7 d CPK差異無(wú)統(tǒng)計(jì)學(xué)意義(P=0.883,P=0.678);觀察組患者術(shù)后3個(gè)月MRI測(cè)T2弛豫時(shí)間明顯比對(duì)照組短,差異有統(tǒng)計(jì)學(xué)意義(P0.001)。結(jié)論 Quadrant通道輔助下經(jīng)椎間孔減壓腰椎融合固定術(shù)的近期療效與傳統(tǒng)后路開放術(shù)一致,且具有肌肉、軟組織損傷小以及早期功能恢復(fù)更加良好等優(yōu)勢(shì)。
[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 鹵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.
【作者單位】： 西安醫(yī)學(xué)院第一附屬醫(yī)院骨科;
【分類號(hào)】：R687.3

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