|
Objective: pedicle screw fixation with traditional open surgery combined interbody fusion of Quadran system comprehensive comparative analysis in the treatment of the lumbar spondylolisthesis laboratory indicators perioperative parameters and imaging evaluation Quadrant expansion system posterior lumbar clinical efficacy and minimally invasive fusion combined with pedicle screw fixation surgery, to provide a reference for further clinical application. Methods: In this study, 61 cases are the Affiliated Hospital of Putian University Orthopaedic 2007-2009 patients, 31 males and 30 females. The slippage nature Newman Classification System Act parting: 26 cases of type Ⅱ, Ⅲ 35 cases. All cases were single segmental spondylolisthesis, the slippage site: L5 21 cases, L4 33 cases, L3 7 Li. The slippage degree of Meyerding method indexing: Ⅰ level 24 cases, Ⅱ degree 37 cases. Included in the study were randomly divided into two groups: the minimally invasive group - Quadrant posterior minimally invasive distraction system assisted surgery patients (n = 30); open group - traditional the posterior open surgery patients (31 cases). Record the operation time of the two groups of patients, perioperative blood loss, postoperative drainage and blood transfusion; determination preoperative one day, after one day and 7 days of hemoglobin, the red blood cell count and creatine kinase level; preoperative day 1 and after 3 months and 1 year for the two groups of patients ODI score low back pain situation the VAS score recorded, in order to assess the degree of clinical improvement and surgical treatment, while imaging (intervertebral height, bone fusion rate) observed. All data SPSS14.0 for windows statistical package for statistical analysis. Results: The two groups of patients in age, sex, duration of disease, body weight, clinical symptoms and signs, disease stage, slipping the degree of spondylolisthesis nature parting aspects, by t-test and X ~ 2 test showed no significant difference (P > 0.05), comparable. Preoperative blood count, hemoglobin, creatine kinase level difference was not statistically significant (P> 0.05), minimally invasive group, blood count, hemoglobin, creatine kinase compared differences was statistically significant (P < 0.05); open group compared the difference was statistically significant (P <0.01). Compared two groups after one day, 7 days hemoglobin, blood count differences was statistically significant (P <0.01); 1 day after the level of creatine kinase difference was statistically significant (P <0.01), postoperative were increased; 7 days after the level of creatine kinase, a statistically significant difference (P <0.05) were decreased, but remained above 1 day before surgery. Minimally invasive group operative time, blood loss, postoperative drainage and postoperative transfusion volume was significantly less than the open group, the difference between the two groups was statistically significant (P <0.01 or P <0.05). Operative time per case average reduction 24.6min, the average reduction of blood loss 425.6ml, 48h after drainage volume average reduction 83.1ml; blood transfusion average reduction 1.53U. Both groups, VAS, ODI, the difference being statistically significant (P <0.01), one day before surgery compared with postoperative March intervertebral height difference was statistically significant (P <0.01), surgery after 3 months and 1 year postoperatively intervertebral height difference (P <0.05). Compared the two groups, after March VAG, ODI was statistically significant (P <0.05), the the intervertebral height difference was not statistically significant (P> 0.05), 1 year after the VAS, ODI score difference was statistically significant (P <0.01), the the intervertebral height difference was statistically significant (P <0.05). Minimally invasive group and open group compared to 3 months after improvement rate difference was not statistically significant (Z = -1.248, P = 0.212> 0.05), the improvement rate one year after the difference was statistically significant (Z = - 2.020, P = 0.043 <0.05); March after excellent rate difference is not obvious (X ~ 2 = 4.239, P = 0.039 <0.05), 1 year after the excellent rate difference (to 2 = 7.517, P = 0.006 <0.01). The fusion rate difference was statistically significant (X to 2 = 4.211, P = 0.04 <0.05). Minimally invasive surgery in the Conclusion: 1.Quadrant system, shorten the time of surgery, reducing surgical blood loss and blood transfusion after saving blood resources. Minimally invasive surgery 2.Quadrant system to reduce the damage to the muscle tissue of patients with traumatic reactions affect significantly lower than open surgery, minimally invasive. Minimally invasive surgery on the spine 3.Quadrant system stability destruction of small, low the late chronic low back pain and leg pain, and is conducive to the functional exercise, to promote the patient's speedy recovery. 4. Compared with traditional open surgery, the Quadrant system minimally invasive surgery is more conducive to the restoration and maintenance of the intervertebral height and normal lumbar sagittal sequence, the high rate of bone fusion. Although there is a lack of long-term follow-up results, but the surgical treatment of short-term changes in operative time, blood loss, postoperative rehabilitation, biochemical markers, or imaging, minimally invasive surgery to open surgery shows unparalleled advantage, as a new minimally invasive spinal techniques worthy of promotion.
|