摘要目的 探讨Quadrant通道下经椎间孔腰椎椎体间融合术治疗复发性腰椎间盘突出症(RLDH)的效果.方法 76例RLDH患者,根据手术方式分为传统经椎间孔腰椎椎体间融合术(TLIF)组36例和Quadrant组40例,比较两组患者的手术情况,VAS评分和ODI评分.结果 Quadrant组手术时间,切口长度,术中出血量,术中引流量均少于传统TLIF组[手术时间:(98.2±18.1) min与(118.5±27.2) min,t=3.79,P<0.05;切口长度:(2.7±0.6) cm与(5.5±1.0) cm,t=14.97,P<0.05;术中出血量:(90.7±20.1) ml与(170.3±33.5)t=12.71,P<0.05;术中引流量:(43.8±12.4) ml与(117.1±28.9) ml,t=14.62,P<0.05];Quadrant组患者下床活动时间,住院时间均短于传统TLIF组[下床活动时间:(2.8±0.6) d与(6.8±1.1) d,t=19.95,P<0.05;住院时间:(7.1±2.0)d与(14.2±2.7)d,t=13.11,P<0.05].术后两组患者VAS评分各时间点比较,从术后3 d到术后6个月,Quadrant组VAS均显著低于传统TLIF组[Quadrant组:(4.4±1.0)、(3.9±1.2)、(3.4±0.8)、(1.9±0.6)、(1.3±0.4)分;传统TLIF组:(5.0±1.4),4.5±1.1)、(4.1±0.9)、(3.6±0.7)、(2.5±0.6)分,P均<0.05].两组患者ODI评分各时间点比较,从术后1 d到术后6个月,Quadrant组ODI均显著低于传统TLIF组[Quadrant组:(36.7±7.1)、(33.4±6.2)、(30.7±4.1)、(27.8±5.3)、(24.5±5.4)、(18.4±4.7)分;传统TLIF组:(39.8±6.0)、(36.8±5.8)、(33.5±6.6)、(31.3±5.1)、(28.9±6.6)、(22.3±5.2)分,P均<0.05].结论 改良微创术治疗RLDH效果明显,手术时间短,创伤小,恢复快,住院时间短.

abstractsObjective To investigate the curative effect of Quadrant channel transforaminal lumbar interbody fusion(TLIF) in the treatment of recurrent lumbar disc herniation(RLDH).Methods Seventy-six cases patients with RLDH were divided into traditional TLIF group(36 cases) and Quadrant group(40 cases) by the different operation modes.The operation,VAS scores and ODI scores were compared between the two groups.Results Operation time((98.2±18.1) min vs.(118.5±27.2) min,t=3.79,P<0.05),incision length((2.7±0.6) cm vs.(5.5±1.0) cm,t=14.97,P<0.05),intraoperative blood loss((90.7±20.1) ml vs.(170.3±33.5) ml,t=12.71,P<0.05) and intraoperative drainage((43.8±12.4) ml vs.(117.1±28.9) ml,t=14.62,P<0.05) in Quadrant group were less than that in traditional TLIF group.The ambulation time((2.8±0.6) d vs.(6.8±1.1) d,t=19.95.P<0.05) and hospitalization time((7.1±2.0) d vs.(14.2±2.7) d,t=13.11,P<0.05) of Quadrant group were shorter than those of TLIF group.VAS scores in both groups were significantly decreased.VAS in Quadrant group was significantly lower than that in traditional TLIF group from 3 d to 6 months after operation((4.4±1.0,3.9±1.2,3.4±0.8,1.9±0.6,1.3±0.4) points vs.(5.0±1.4,4.5±1.1,4.1±0.9,3.6±0.7,2.5±0.6) points,P<0.05).ODI scores in both groups were significantly decreased.ODI in Quadrant group was significantly lower than that in traditional TLIF group from 1 d to 6 months after operation((36.7±7.1,33.4±6.2,30.7±4.1,27.8±5.3,24.5±5.4,18.4±4.7) points vs.(39.8±6.0,36.8±5.8,33.5±6.6,31.3±5.1,28.9±6.6,22.3±5.2) points,P<0.05).Conclusion The treatment of RLDH by Quadrant channel TLIF has obvious curative effect,short operation time,less trauma,faster recovery and shorter hospital stay.