经Quadrant通道下经肌间隙入路治疗腰椎间盘突出症的效果及对腰椎功能恢复疼痛程度及影像学参数的影响

doi:10.3969/j.issn.1006-6233.2024.05.020

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摘要 目的: 探究经Quadrant通道下经肌间隙入路治疗腰椎间盘突出症(Lumbar Intervertebral Disc Herniation,LDH)的效果及对腰椎功能恢复、疼痛程度及影像学参数的影响。方法: 选取我院2020年3月至2023年3月期间收治的拟行椎间隙融合手术(Transforaminal lumbar interbody fusion,TLIF)的LDH患者102例,采用随机数字表法分为观察组和对照组各51例,对照组采用传统开放入路方式行TLIF治疗,观察组采用经Quadrant通道下经肌间隙入路方式行TLIF治疗。比较两组患者手术情况;MacNab标准评价术后康复效果;于术前、术后1周、术后3个月和术后6个月比较Oswestry功能障碍指数(Oswestry Disability Index,ODI)和腰痛数字评分法(Numeric Rating Scale for pain,NRS)评价腰椎功能恢复情况和疼痛程度;比较术前和术后6个月腰椎-骨盆矢状位影像学参数[腰椎前凸角(Lumbar lordosis angle,LL)、腰骶角(Lumbosacral angle,LSA)、骨盆倾斜角(Pelvic tilt,PT)、骶骨倾斜角(Sacral slope,SS)和骨盆入射角(Pelvic incidence,PI)]变化情况;观察两组并发症发生情况。结果: 观察组手术用时和术后下地时间均短于对照组(P<0.05),术中出血量和术后引流量均少于对照组(P<0.05);术后6个月时,优良率98.04%明显高于对照组84.32%(P<0.05);ODI评分和腰痛NRS评分的组间效应、时间效应、分组与时间的交互作用均有统计学意义(P<0.05),两组评分随时间变化均呈现下降趋势,且观察组下降趋势更为明显(P<0.05);术后6个月时LL均较术前显著降低,且观察组下降程度高于对照组(P<0.05),但LSA、PT、SS和PI两组差异无统计学意义(P>0.05);术后6个月,观察组并发症总发生率低于对照组(P<0.05)。结论: 经Quadrant通道下经肌间隙入路行TLIF治疗LDH相较于传统开放入路的TLIF创伤更小,操作更简洁,患者术后腰椎功能恢复进程更快,有助于进一步降低疼痛程度,并提高患者腰椎稳定性,具有较高安全性。

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	李斌
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关键词 ： Quadrant通道, 腰椎间盘突出, 腰椎功能, 疼痛, 影像学参数

Abstract：Objective: To explore the effect of intermuscular approach under Quadrant channel in the treatment of lumbar disc herniation (LDH) and its influence on lumbar function recovery, pain degree and imaging parameters. Methods: A total of 102 patients with LDH who were scheduled to undergo transforaminal lumbar interbody fusion (TLIF) in our hospital were enrolled from March 2020 to March 2023, and were divided into observation group (51 cases) and control group (51 cases) by adopting random number table method. The control group was treated with TLIF through traditional open approach, and the observation group was given TLIF through intermuscular approach under Quadrant channel. The surgical conditions of the two groups were compared. MacNab standard was used to evaluate the postoperative rehabilitation effect. Oswestry disability index (ODI) and low back pain numerical rating scale (NRS) were applied to assess the lumbar function recovery and pain degree before surgery and at 1 week, 3 months and 6 months after surgery. The changes in lumbar-pelvic sagittal imaging parameters [lumbar lordosis angle (LL), lumbosacral angle (LSA), pelvic tilt angle (PT), sacral slope (SS) and pelvic incidence angle (PI)] were compared before surgery and at 6 months after surgery, and the complications of the two groups were observed. Results: The surgical time and postoperative ambulation time in observation group were shorter (P<0.05), and the intraoperative blood loss and postoperative drainage volume were less than those in control group (P<0.05). At 6 months after surgery, the excellent and good rate of 98.04% was significantly higher than 84.32% in control group (P<0.05). ODI score and lumbar pain NRS score showed statistically significant differences in inter-group effect, time effect, and interaction between grouping and time (P<0.05). Both scores exhibited a decreasing trend over time, with a more pronounced decreasing trend observed in the observation group (P<0.05). At 6 months after surgery, the LL angle significantly decreased compared to the preoperative values in both groups, and the decrease was more pronounced in the observation group than in the control group (P<0.05), but there were no obvious differences in LSA, PT, SS and PI between the two groups (P>0.05). At 6 months after surgery, the total incidence rate of complications was significantly lower in observation group than that in control group (P<0.05). Conclusion: Compared with TLIF through traditional open approach, TLIF through intermuscular pproach under Quadrant channel for LDH has smaller trauma, simpler operation and faster recovery of postoperative lumbar function, and it is helpful to further reduce the pain degree and improve the lumbar stability, and it has high safety.

Key words： Quadrant channel Lumbar disc herniation Lumbar function Pain Imaging parameters

基金资助:2022年安徽省重点研究与开发计划项目,(编号:2022e07020058)

通讯作者: 胡强

引用本文:

李斌, 蔡金蕾, 田军, 胡强. 经Quadrant通道下经肌间隙入路治疗腰椎间盘突出症的效果及对腰椎功能恢复疼痛程度及影像学参数的影响[J]. 河北医学, 2024, 30(5): 814-819.
LI Bin, CAI Jinlei, TIAN Jun, et al. Effect of Intermuscular Approach under Quadrant Channel in Treating Lumbar Disc Herniation and Its Influence on Lumbar Function Recovery, Pain Degree and Imaging Parameters. HeBei Med, 2024, 30(5): 814-819.

链接本文:

http://www.hbyxzzs.cn/CN/10.3969/j.issn.1006-6233.2024.05.020 或 http://www.hbyxzzs.cn/CN/Y2024/V30/I5/814

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