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Wiltse入路单侧MIS-TLIF联合对侧经皮内固定术治疗极外侧型腰椎间盘突出症的疗效分析
The curative effect of Wiltse approach and transforaminal lumbar interbody fusion via Quadrant with contralateral percutaneous pedicle screw fixation for the treatment of far lateral lumbar disc herniation
  
DOI:
中文关键词:  极外侧型腰椎间盘突出  Mast Quadrant系统  Wiltse入路  MI-TLIF  经皮椎弓根螺钉内固定术  微创手术
英文关键词:Far lateral lumbar disc herniation  Mast Quadrant system  Wiltse approach  Transforminal lumbar interbody fusion  Percutaneous pedicle screw fixation  Minimally invasive surgery
基金项目:
作者单位
孙志波 郭骏 陈荣 郭潇 李相伟 肖亮 赵林 陈驰 禹志宏*  
通讯作者:孙志波 郭骏 陈荣 郭潇 李相伟 肖亮 赵林 陈驰 禹志宏*    
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中文摘要:
      目的 探讨并分析Quadrant通道下经Wiltse入路单侧MIS-TLIF(Minimally Invasive transforminal lumbar interbody fusion)联合对侧Sextant经皮钉棒系统内固定术(percutaneous pedicle screw fixation, PPSF)治疗单节段极外侧型腰椎间盘突出症(far lateral lumbar disc herniation, FLLDH)的中期临床疗效。方法 2012年5月至2015年5月共治疗极外侧型腰椎间盘突出症病例30例,均采用Quadrant通道下经Wiltse入路单侧MIS-TLIF联合对侧Sextant经皮钉棒系统内固定术。记录手术时间、术中出血量及X线暴露次数,疼痛视觉模拟评分VAS、腰椎JOA功能评分;按改良Macnab标准评价优良率;根据Bridwell法评估椎间植骨融合情况。结果 30人获随访,时间12~26个月。平均手术时间110 min;平均术中出血量155 mL;平均X线暴露次数26.6次。末次随访时VAS及JOA评分与术前相比差异有统计学意义(P<0.05)。末次随访时根据改良Macnab标准优良率为96.7%。按Bridwell椎间融合标准本组融合率为100%,平均椎间融合时间为8.6个月。结论 微创Quadrant通道下经Wiltse入路单侧MIS-TLIF联合对侧Sextant经皮钉棒系统内固定术治疗单节段极外侧型腰椎间盘突出症中期临床疗效满意,具有手术创伤小、出血少、恢复快,能有效维持术后脊柱稳定性等优点,其远期效果有待进一步研究。
英文摘要:
      Objective To investigate the mid-term clinical efficacy of Wiltse approach and transforaminal lumbar interbody fusion via Quadrant with contralateral percutaneous pedicle screw fixation for the treatment of far lateral lumbar disc herniation. Method Thirty selective patients with single level FLLDH who underwent Wiltse approach and transforaminal lumbar interbody fusion via Quadrant with contralateral percutaneous pedicle screw fixation from May 2012 to May 2015 were retrospectived investigated. The follow-up evaluation included operative time, blood loss, X-Ray, VAS score and JOA score. Subjective satisfaction with the result of surgery was classified as excellent, good, fair, and poor based on MacNab criteria. Bridwell method was used to evaluate the lumbar interbody fusion. Results All patients were followed up for 12 to 26 months. Median operation time was 140 min, estimated blood loss during the procedure was added up to a mean of 155 mL, median operation X-ray exposure time was 26.6 times. VAS and JOA score were showed statistical significance between preoperation and final follow-up (P<0.05). According to reforming Macnab standard, the results were excellent in 25 cases and good in 4 cases at the last follow-up. All cases got bony fusion with the mean fusion time of 8.6 months. Conclusion The Wiltse approach and transforaminal lumbar interbody fusion via Quadrant with contralateral percutaneous pedicle screw fixation turn out to be safe and effective alternative procedure for the treatment of far lateral lumbar disc herniation, but the long-term effect still need study.
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