象限牵开器治疗复发性腰椎间盘突出症的短期疗效

Teng Haijun, Wang Liang, Guo Zhiliang, Fan Lijing, Zhang Dahai, Liu Chao, Wang Shidong

Department of Spine Surgery, 89th Hospital of Chinese PLA, Weifang Shandong 261021, PR China.

Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2011 Aug;25(8):960-3.

OBJECTIVE

To investigate the effectiveness of Quadrant retractor for the treatment of recurrent lumbar disc protrusion.

METHODS

Between July 2008 and March 2010, 18 cases of recurrent lumbar disc protrusion were treated with Quadrant. There were 13 males and 5 females with an average age of 43 years (range, 35-67 years). Involved segments included L4, 5 in 6 cases and L5, S1 in 12 cases. The time between first operation and recurrence was 12-120 months (mean, 42.8 months). Before operation, radiological evaluation including X-ray, CT, and MRI were performed. Visual analogue scale (VAS) score and modified MacNab criteria were used to evaluate the effectiveness.

RESULTS

The operation time was 40-80 minutes (mean, 60 minutes), and the amount of blood loss was 80-120 mL (mean, 100 mL). All operations were performed successfully, and no complication of infection and nerve injury occurred. Incisions healed by first intention. Cerebrospinal fluid leakage occurred in 2 cases and was cured at 3 days after operation by removal of drainage. Eighteen patients were followed up 12-30 months (mean, 22 months). The VAS score of leg pain was decreased from 7.3 +/- 2.2 preoperatively to 2.0 +/- 1.3 at the final follow-up, showing significant difference (t = 11.08, P = 0.00). According to modified MacNab criteria, the results were excellent in 12 patients and good in 6 patients. No recurrence was found during follow-up.

CONCLUSION

Discectomy via Quadrant retractor is a safe and effective minimally invasive surgical technique in treating recurrent lumbar disc protrusion.

目的

探讨Quadrant牵开器治疗复发性腰椎间盘突出症的有效性。

方法

2008年7月至2010年3月，采用Quadrant牵开器治疗18例复发性腰椎间盘突出症患者。其中男性13例，女性5例，平均年龄43岁（35 - 67岁）。受累节段包括L4、5共6例，L5、S1共12例。首次手术至复发时间为12 - 120个月（平均42.8个月）。术前进行了包括X线、CT和MRI在内的影像学评估。采用视觉模拟评分法（VAS）和改良MacNab标准评估疗效。

结果

手术时间为40 - 80分钟（平均60分钟），出血量为80 - 120毫升（平均100毫升）。所有手术均顺利完成，未发生感染和神经损伤并发症。切口一期愈合。2例发生脑脊液漏，术后3天通过拔除引流治愈。18例患者随访12 - 30个月（平均22个月）。腿痛VAS评分从术前的7.3±2.2降至末次随访时的2.0±1.3，差异有统计学意义（t = 11.08，P = 0.00）。根据改良MacNab标准，结果优12例，良6例。随访期间无复发。