中国组织工程研究
中國組織工程研究
중국조직공정연구
Journal of Clinical Rehabilitative Tissue Engineering Research
2013年
30期
5563-5568
,共6页
魏劲松%曾荣%陈思圆%魏波%林颢
魏勁鬆%曾榮%陳思圓%魏波%林顥
위경송%증영%진사원%위파%림호
骨关节植入物%骨与关节学术探讨%Quadrant系统%腰椎间盘突出症%腰椎不稳%椎弓根钉固定%植骨融合%腰椎管减压%椎间盘摘除
骨關節植入物%骨與關節學術探討%Quadrant繫統%腰椎間盤突齣癥%腰椎不穩%椎弓根釘固定%植骨融閤%腰椎管減壓%椎間盤摘除
골관절식입물%골여관절학술탐토%Quadrant계통%요추간반돌출증%요추불은%추궁근정고정%식골융합%요추관감압%추간반적제
bone and joint implants%academic discussion of bone and joint%Quadrant System%lumbar intervertebral disc protrusion%lumbar instability%pedicle screw fixation%bone graft fusion%lumbar spinal canal decompression%disc resection
背景：腰椎间盘突出症手术后仍有10%-30%的患者症状缓解不明显，统称为腰椎术后失败综合征，而腰椎不稳是其中的一个重要原因。目的：探讨Quadrant系统下后路腰椎管减压、椎间盘摘除、椎间融合和椎弓根螺钉固定治疗腰椎间盘突出症合并腰椎不稳可行性和有效性。方法：2011年12月至2012年10月应用Quadrant系统行后路腰椎管减压、椎间盘摘除、椎间植骨加融合器置入、椎弓根螺钉固定治疗腰椎间盘突出症合并腰椎不稳患者62例，男38例，女24例。年龄37-69岁，平均年龄为53.7岁，治疗后随访评价治疗效果。结果与结论：手术时间为90-210 min，平均时间145 min。术中失血量50-300 mL，平均失血量120 mL。治疗后住院时间5-9 d，平均住院时间6 d。手术切口均一期愈合。随访3-10个月，平均7.2个月。JOA评分治疗前为(10.25±2.34)分，治疗后1个月及末次随访时分别为(18.31±3.12)分和(25.35±2.61)分。与治疗前比较均有显著性差异(P <0.01)。目测类比评分治疗前为(8.24±1.15)分，治疗后1个月及末次随访时分别为(2.97±1.12)分和(1.13±0.39)分。与治疗前比较均有显著性差异(P <0.01)。末次随访时采用改良Macnab标准评价临床效果，优53例，良9例。证明Quadrant系统下后路腰椎管减压、椎间盘摘除、椎间融合和椎弓根螺钉固定治疗腰椎间盘突出症合并腰椎不稳，是一种安全有效的微创治疗方法。
揹景：腰椎間盤突齣癥手術後仍有10%-30%的患者癥狀緩解不明顯，統稱為腰椎術後失敗綜閤徵，而腰椎不穩是其中的一箇重要原因。目的：探討Quadrant繫統下後路腰椎管減壓、椎間盤摘除、椎間融閤和椎弓根螺釘固定治療腰椎間盤突齣癥閤併腰椎不穩可行性和有效性。方法：2011年12月至2012年10月應用Quadrant繫統行後路腰椎管減壓、椎間盤摘除、椎間植骨加融閤器置入、椎弓根螺釘固定治療腰椎間盤突齣癥閤併腰椎不穩患者62例，男38例，女24例。年齡37-69歲，平均年齡為53.7歲，治療後隨訪評價治療效果。結果與結論：手術時間為90-210 min，平均時間145 min。術中失血量50-300 mL，平均失血量120 mL。治療後住院時間5-9 d，平均住院時間6 d。手術切口均一期愈閤。隨訪3-10箇月，平均7.2箇月。JOA評分治療前為(10.25±2.34)分，治療後1箇月及末次隨訪時分彆為(18.31±3.12)分和(25.35±2.61)分。與治療前比較均有顯著性差異(P <0.01)。目測類比評分治療前為(8.24±1.15)分，治療後1箇月及末次隨訪時分彆為(2.97±1.12)分和(1.13±0.39)分。與治療前比較均有顯著性差異(P <0.01)。末次隨訪時採用改良Macnab標準評價臨床效果，優53例，良9例。證明Quadrant繫統下後路腰椎管減壓、椎間盤摘除、椎間融閤和椎弓根螺釘固定治療腰椎間盤突齣癥閤併腰椎不穩，是一種安全有效的微創治療方法。
배경：요추간반돌출증수술후잉유10%-30%적환자증상완해불명현，통칭위요추술후실패종합정，이요추불은시기중적일개중요원인。목적：탐토Quadrant계통하후로요추관감압、추간반적제、추간융합화추궁근라정고정치료요추간반돌출증합병요추불은가행성화유효성。방법：2011년12월지2012년10월응용Quadrant계통행후로요추관감압、추간반적제、추간식골가융합기치입、추궁근라정고정치료요추간반돌출증합병요추불은환자62례，남38례，녀24례。년령37-69세，평균년령위53.7세，치료후수방평개치료효과。결과여결론：수술시간위90-210 min，평균시간145 min。술중실혈량50-300 mL，평균실혈량120 mL。치료후주원시간5-9 d，평균주원시간6 d。수술절구균일기유합。수방3-10개월，평균7.2개월。JOA평분치료전위(10.25±2.34)분，치료후1개월급말차수방시분별위(18.31±3.12)분화(25.35±2.61)분。여치료전비교균유현저성차이(P <0.01)。목측류비평분치료전위(8.24±1.15)분，치료후1개월급말차수방시분별위(2.97±1.12)분화(1.13±0.39)분。여치료전비교균유현저성차이(P <0.01)。말차수방시채용개량Macnab표준평개림상효과，우53례，량9례。증명Quadrant계통하후로요추관감압、추간반적제、추간융합화추궁근라정고정치료요추간반돌출증합병요추불은，시일충안전유효적미창치료방법。
BACKGROUND:There are stil about 10%-30%of patients presenting no obvious improvement of symptoms after lumbar disc herniation surgery, which are col ectively known as the lumbar spine post-surgery failure syndrome, and lumbar instability is one of the important reasons. OBJECTIVE:To evaluate the feasibility and efficacy of surgery including posterior lumbar spinal canal decompression, intervertebral disc resection, lumbar interbody fusion, and pedicle screw fixation on lumbar intervertebral disc protrusion concurring lumbar instability via MAST Quadrant retractor. METHODS:From December 2011 to October 2012, 62 cases of lumbar intervertebral disc protrusion concurring lumbar instability were treated with posterior lumbar spinal canal decompression, intervertebral disc resection, lumbar interbody fusion, and pedicle screw fixation via MAST Quadrant retractor. There were 38 female and 24 male ranging in age from 37 to 69 years (average 53.7 years). After operation, al patients were fol owed-up to evaluate the effect of the treatment. RESULTS AND CONCLUSION:The operative time was 90-210 minutes, average 145 minutes, and the amount of blood loss was 50-300 mL, average 120 mL. The hospitalization time was 5-9 days, average 6 days. Al incisions healed by first intention. Al patients were fol owed up 7.2 months on average (from 3 to 10 months). The preoperative JOA score was (10.25±2.34) points. The postoperative JOA score decreased to (18.31±3.12) points at the fol ow-up after 1 month and (25.35±2.61) points at the last fol ow-up, showing significant difference when compared with preoperative score (P<0.01). The preoperative VAS score was (8.24±1.15) points. The postoperative VAS score decreased to (2.97±1.12) points after 1 month and (1.13±0.39) points at the last fol ow-up, showing significant difference when compared with preoperative score (P<0.01). According to reforming Macnab standard, the results were excel ent in 53 cases and good in 9 cases at the last fol ow-up. The surgery including posterior lumbar spinal canal decompression, intervertebral disc resection, lumbar interbody fusion, and pedicle screw fixation via MAST Quadrant retractor is a safe, effective and minimal y invasive surgical technique in treating lumbar intervertebral disc protrusion concurring lumbar instability.
