RESUMO
Objective To investigate the clinical application value of Quadrant system combined with percutaneous pedicle screw fixation for treatment of lumbar degenerative disease.Methods The clinical data of 40 patients who sufferred from lumbar degenerative disease,were randomly divided into two groups:Quadrant system combined with percutaneous pedicle screw fixation to do discectomy and intervertebral bone graft fusion as invasive group (n =20),traditional posterior lumbar interbody fusion as conventional group (n =20).The operation time,length of incision,blood loss,postoperative drainage,JOA score of preoperation and postoperation,and effect (reforming Macnab standard) between two groups were recorded and compared.Results Operations were all well done in two groups.The operation time in invasive group was longer than that in traditional group [(147.3 ± 8.9) min,(136.7 ± 10.2) min,t =3.5,P ＜ 0.05].The length of incision [(3.65 ± 0.68) cm,(1 1.11 ± 1.29) cm,t =22.88,P ＜ 0.05)],blood loss [(205.00 ± 63.04) mL,(270.50 ± 77.58) mL,t =2.93,P ＜ 0.05],postoperative drainage [(90.3 ± 10.8) mL,(180.6 ± 1 3.9) mL,t =22.96,P ＜ 0.05] and days in hospital [(16.9 ± 2.0) days,(18.9 ± 2.1)days,t =3.05,P ＜ 0.05] in invasive group were all less.than those in traditional group (P ＜ 0.05).All cases had been followed up for 6-18 months,average of 13 months.There were no significant differences in excellent and good rate (reforming Macnab standard) between two groups in the last following up (P ＞ 0.05).There were no significant differences of JOA scores in preoperation [(12.0 ± 1.7) points,(11.0 ± 1.5) points,P ＞ 0.05],postoperative half a year [(22.0 ± 2.3) points,(21.0 ± 2.5) points,P ＞ 0.05],and postoperative one year [(23.0 ± 1.9) points,(22.0 ± 2.0) points,P ＞ 0.05].Conclusion Quadrant system combined withpercutaneous pedicle screw fixation is a safe,effective and minimally invasive surgical technique in treating lumbar degenerative disease.Compared with conventional group,invasive group has advantages such as less injury,less blood loss,simple operation,and good curative effect,which should be popularized.
RESUMO
BACKGROUND:In recent years, pedicle internal fixation, spinal canal decompression and bone graft fusion have been used in the treatment of degenerative lumbar spondylolisthesis complicated by lumbar spinal stenosis and have achieved good results, which increase the fusion rate. However, there is a large difference between the therapeutic effects of different surgical methods. OBJECTIVE:To contrast the repair effect of posterior and transforaminal lumbar interbody fusion on degenerative lumbar spondylolisthesis complicated by lumbar spinal stenosis. METHODS:Forty patients with degenerative lumbar spondylolisthesis complicated by lumbar spinal stenosis were enroled, including 11 males and 29 females, aged 56-74 years. Al patients received the combined treatment of pedicle internal fixation, spinal canal decompression and bone graft fusion. The 19 of 40 patients received posterior lumbar interbody fusion and the rest 21 patients underwent transforaminal lumbar interbody fusion. Al the patients were folowed up for 6 months after treatment, and the visual analog scores, Oswestry function index, bone fusion rate, lumbar function score and complication occurrence were analyzed and compared between the two groups. RESULTS AND CONCLUSION:The visual analog scores and Oswestry function index were both improved significantly in the two groups at 6 months after treatment (P < 0.05). No difference was found in the bone fusion rate, visual analog scores and Oswestry function index between the two groups. But compared with the posterior lumbar interbody fusion group, the lumbar functional recovery and incidence of complications were better in the transforaminal lumbar interbody fusion group (P < 0.05). These findings indicate that both posterior and transforaminal lumbar interbody fusions for degenerative lumbar spondylolisthesis complicated by lumbar spinal stenosis can achieve good results in the bone fusion rate, and however, the transforaminal lumbar interbody fusion is better to protect the nerve root and dural sac and to promote lumbar functional recovery.