Clinical Research On Interbody Fusion And Pedicle Screw Fixation Assisted By Quadrant System In The Treatment Of Lumbar Spondylolisthesis

Objective:Through minimally invasive interbody fusion and pedicle screw fixation assisted by METRx-Quadran Posterior Distraction System and traditional open surgery in the treatment of lumbar spondylolisthesis surgery time, blood loss volume, postoperative drainage, the extent of local tissue injury and the rate of fusion comprehensive comparative analysis, evaluate Quadrant Posterior Distraction System system Clinical efficacy and minimally invasive in the posterior lumbar spondylolisthesis surgery, and explore surgical techniques in order to guide clinical surgery, give instructions to further clinical practices.Methods:There are 61 patients in this group, in which 30 patients are male and 31 are female. All cases were collected from orthopaedic department of Affiliated Hospitals of Putian Institute of 2007-2009. II-type 26 and HI type 35 cases according to the classification system by Newman. All cases are single-segmental spondylolisthesis: 21 L5 segment slippage, 33 L4 segment slippage , 7 L3 segment slippage. Grade I 24 and Grade II 37 according to the classification by Meyerding.All the patients were dividede into tow groups at random, using Quadrant Posterior minimally invasive surgery system as invasive group(30 cases)and traditional open surgery in patients as open group (31 cases). To calculate bleeding volume in operation and post-operative drainage volume and blood transfusion. To determin HB,RBC and CK level separately in 1 day before surgery, 1 day after surgery and 7 days after surgery. The Clinical outcome according to relief of pain was assessed using the scoring system of visual analogue scale (VAS) and. the scoring system of Oswestry disability index (ODI) for low back pain. In radiographic assessment: Preoperativeand 1 day,3 month and last follow-up (12 month) radiographs were analyzed including the index of relative posterior disc height.All data used SPSS14.0 for windows software package for statistical analysis.Results:1,Two groups patients are not striking different on age,gender,body weight,Clinical manifestations and signs,Incidence of stage,degree and type of spondylolisthesis(P>0.05).2,In analysis of blood cells:HB,RBC,and CK level in 1 day before surgery are no significant difference (P> 0.05),but the inter-and intra-groups after 1d and after 7d are significantly different (P<0.01) and in 7 days after surgery are significantly improved which compared with the open group are also difference (P<0.01).Leves of CK activity peaked at 1d after surgery in both group, Invasive group displayed a less significant postoperative rise in serum at 1d after surgery than in open group and descended at 7d.Invasive group on CK level after 1d is significant difference (P <0.01)and in 7 days after surgery is only with statistical significance difference (P< 0.05), which compared with the open group is significant difference (P < 0.01).3,The Operation time of Invasive group is less than open group(P< 0.05).The Invasive group of bleeding volume in operation and postoperative drainage volume of 48h are significantly less than the open group. The two group are differences(P<0.01). The amount of average hemorrhage are425.60ml.The amount of average drainage volume of 48h is respectively 8.1 ml. The average amount of blood transfusion is 3U.4,By visual analogue scale (VAS) and Oswestry Disabilitylndex(ODI), there were nosignificant diference in two groups before operation(P>0.05) . Relative posterior disc height of the inter-and after 3m is no significantly different(P>0.05) and after 12m is only with statistical significance difference (P< 0.05). The. score of VAS and ODI of invasive groupare less than open group in 3m and 12m after surgery(P<0.01).5,The improvement rates of two groups according to ODI values acquired from 12m after surgery(P=0.007<0.01) is significant diference more than 3m after surgery(P=0.026<0.05). Few difference between 2 groups was found via computing the execellent and good rate ,and going with the time-lapse,the rate fluctuating range observed slight also.Conclusion:Both groups had good clinical outcomes,however ,the less response of CK levels and smllaer magnitude of paravertebral muscle damage support that the minimally invisive operation with Quadrant is less traumatic to patients than tradional open operation.