Transforaminal lumbar interbody fusion via Quadrant system: early correction of lumbar spondylolisthesis

doi:10.3969/j.issn.2095-4344.2015.17.014

Abstract

Abstract:

BACKGROUND: Conventional therapies for lumbar spondylolisthesis can result in trauma, bleeding and low back pain. With the vigorous development of spinal biomechanics and novel spinal fixation systems, we have more understanding on the reduction and fusion after spondylolisthesis.

OBJECTIVE: To observe the clinical effects of transforaminal lumbar interbody fusion via the quadrant system on lumbar spondylolisthesis and related biomechanical changes.

METHODS: A retrospective analysis was done in 23 patients with lumbar spondylolisthesis undergoing transforaminal lumbar interbody fusion via the quadrant system admitted from June 2012 to September 2013. Oswestry disability index and visual analog scale score were detected at 3 months and 1 year after treatment, as well as fusion conditions and internal fixation with or without loosening or breakage.

RESULTS AND CONCLUSION: All patients were successfully treated, with no cerebrospinal fluid leakage and nerve injury. Incisions were healed well in all cases except one case suffered from incision infection that was controlled after 10 days of antibiotic treatment. All the patients were followed up. The Oswestry disability indexes and visual analog scale scores were significantly improved at 3 months and 1 year after treatment (P < 0.05), but there was no difference in these two scores at 3 months and 1 year after treatment (P > 0.05). The improvement rates of Oswestry disability index and visual analog scale score were (65.3±14.8)% and (58.2±12.0)%, respectively. These findings indicate that the transforaminal lumbar interbody fusion via the quadrant system is safe and effective to correct lumbar spondylolisthesis, maintains the biomechanical stability, improves patient’s symptoms, reduces the incidence of low back pain and improves the quality of life.

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

全文链接：

Key words: Spinal Fusion, Spondylolysis, Surgical Procedures, Minimally Invasive, Internal Fixators, Bone Nails

CLC Number:

R318

Hao Ying-jie, Li Zhi-lei, Yu Lei, Zhang Di, Liu Tao. Transforaminal lumbar interbody fusion via Quadrant system: early correction of lumbar spondylolisthesis[J]. Chinese Journal of Tissue Engineering Research, 2015, 19(17): 2699-2703.

Figures/Tables 1

2.1 参与者数量分析按意向性处理，23例患者均顺利完成治疗，随访均达到1年，全部进入结果分析，无脱落。 2.2 随访结果所有患者均顺利完成治疗。在住院期间1例切口感染、抗生素治疗10 d后切口甲级愈合，无神经根或马尾损伤，脑脊液漏等并发症。治疗后复查X射线片示均得以复位，植骨充分，椎弓根螺钉位置良好。手术时间平均(135±21) min，出血平均(260±86) mL，平均住院时间为13 d(8-17 d)。所有病例均获得有效随访，随访时间1年。 2.3 临床效果分析经统计学分析(配对t 检验)，治疗后3个月及1年随访时Oswestry功能障碍指数均较治疗前明显恢复，差异有显著性意义(P < 0.05)，治疗后3个月与1年随访时比较差异无显著性意义(P > 0.05)；随访1年时改善率为(65.3±15.4)%。治疗后3个月及1年随访时疼痛目测类比评分均较治疗前明显改善，差异有显著性意义(P < 0.05)，治疗后3个月与1年随访时比较差异无显著性意义(P > 0.05)；治疗后1年随访时改善率为(58.2±12.0)% (见表1)。植骨融合情况：治疗后1年进行植骨融合评定，融合23例，未融合0例，融合率100%(23/23)。 2.4 典型病例女性患者，63岁，长期反复发作的下腰部疼痛伴左下肢酸胀、无力10余年，加重半年，保守治疗半年无效。影像学表现为L4椎体Ⅰ度滑脱伴L4-5椎间盘突出，Quadrant 通道下经椎间孔椎间融合治疗后，滑脱复位满意，下腰痛及根性症状得到明显缓解(见图1)。 2.5 不良事件 1例患者治疗后3 d出现切口处红肿、有血性分泌物渗出，体温最高至38.9 ℃，切口处分泌物及血液标本均送培养，血培养结果为阴性、分泌物培养为：表皮葡萄球菌，敏感抗生素应用2 d后，患者体温控制，1周后切口处未再有渗出物，治疗后16 d拆除缝线，切口已愈合。术中注意保护切口，增加切口内冲洗次数均能有效预防术后感染。 "

References

1]邱贵兴,戴尅戎.骨科手术学[M].3版.北京:人民卫生出版社,2012.
[2]范里,杨波,徐勇,等.MASTTM QUADRANTTM可扩张通道管系统与椎间盘镜治疗腰椎间盘突出症的临床分析[J].中国现代手术学杂志,2012,16(2):122-125.
[3]王志荣,陆爱清,杨惠林,等.Quadrant通道下TLIF术治疗复发性腰椎间盘突出症的疗效分析[J].中国脊柱脊髓杂志,2014, 24(2): 121-126.
[4]Kinl KT,Lee SH,Suk KS,et al.The quantitative analysis of tissue injury markers after mini-open lumbar fusion.Spine. 2006;31(6):712-716．
[5]Ghahrenlan A,Ferch RD,Ra PJ,et al.Minimal access versus open posterior lumbar interbody fusion in the treatment of spondylolisthesis.Neurosugery. 2010;66(2):296-304.
[6]Suk SI, Lee CK, Kim WJ, et al. Adding posterior lumbar interbody fusion to pedicle screw fixation and posterolateral fusion after decompression in spondylolytic spondylolisthesis. Spine. 1997;22(2): 210-219.
[7]Rihn JA, Gandhi SD. Disc space preparation in transforaminal lumbar interbody fusion: a comparison of minimally invasive and open approaches. Clin Orthop Relat Res. 2014;472(6): 1800-1805.
[8]Ghahrenlan A,Ferch RD,Rao PJ,et al．Minimal access versus open posterior lumbar interbody fusion in the treatment of spondylolisthesis. Neurosurgery. 2010;66(2):296-304.
[9]王银,陈根元,胡龙, 等.开放与微创经椎间孔椎体间融合治疗单节段退行性腰椎疾病的Meta分析[J].中国组织工程研究,2013, 17(13):2415-2422.
[10]Park Y, Ha JW.The effect of a radiographic solid fusion on clinical outcomes after minimally invasive transforaminal lumbar interbody fusion. Spine. 2011;11(3): 205-212.
[11]黎庆初,胡辉林,刘宝戈, 等.多裂肌间隙入路微创手术治疗腰椎滑脱症[J].中国脊柱脊髓杂志,2011,21(4):303-307.
[12]邵诗泽,张恩忠,付松, 等.腰骶段多裂肌的形态特点及功能意义[J].中国临床解剖学杂志,2010,28(1):17-19.
[13]桂柯科,俞永林,赵明东, 等.中国人Wiltse椎旁肌间隙入路的观察与测量[J].中国组织工程研究,2014,18(22):3504-3509.
[14]王贵清,蔡显义,汤勇智, 等.Quadrant微创通道下单切口治疗腰椎间盘突出症伴节段不稳[J].中华临床医师杂志(电子版),2011, 5(11):3357-3359.
[15]贺石生.微创可扩张通道辅助腰椎融合术之管见[J].中华骨科杂志,2011,31(10):1022-1023.
[16]赵新建,谭家驹,廖绪强,等.腰椎滑脱的减压、内固定与融合术[J].中华骨科杂志,2002,22(2):72-75.
[17]王建,周跃,张正丰,等.微创经椎间孔腰椎体间融合术治疗腰椎滑脱症的临床研究[J].中华外科杂志,2011,49(22):1076-1080.
[18]刘红光,吴小涛,唐根林,等.通道下单侧椎体间减压融合内固定结合对侧经皮椎弓根螺钉内固定治疗腰椎退变性疾病[J].实用骨科杂志,2014,20(6):488-491.
[19]范顺武,方向前,赵兴,等.微创经椎间孔腰椎椎体间融合术治疗下腰椎疾病[J].中华骨科杂志,2007,27(2):81-85.
[20]Kim KT, Lee SH, Suk KS, et al. The quantitative analysis of tissue injury markers after mini-open lumbar fusion. Spine. 2006;31(6):712-716.
[21]Parker SL, Lerner J. Effect of minimally invasive technique on return to work and narcotic use following transforaminal lumbar inter-body fusion: a review.Prof Case Manag. 2012; 17(5):229-235.
[22]Perez-Cruet MJ, Hussain NS. Quality-of-life outcomes with minimally invasive transforaminal lumbar interbody fusion based on long-term analysis of 304 consecutive patients. Spine. 2014;39(3):191-198.
[23]颜登鲁,李健,高梁斌, 等.两种椎间植骨融合术治疗退行性腰椎滑脱症的疗效比较[J].中华外科杂志,2008,46(7):497-500.

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