改良经椎间孔椎体间融合术治疗腰椎退行性疾病  

Treatment of lumbar degenerative disease with modified transforaminal lumbar interbody fusion

作　　者：张绍东[1] 滕宇飞[2] 许龙吉[3] 吴小涛[1] 茅祖斌[1] 陈辉[1] 孔翔飞[1] 王宸[1] 

机构地区：[1]东南大学附属中大医院骨科,南京210009 [2]吉林大学第四医院骨科,长春130012 [3]吉林省延边第二人民医院骨科,延吉133001

出　　处：《中国矫形外科杂志》2008年第11期811-814,共4页Orthopedic Journal of China

摘　　要：[目的]探讨改良经椎间孔椎体间融合术（transforaminal lumbar interbody fusion，TLIF）用于腰椎退行性疾病的手术方法及疗效。[方法]2003年10月～2005年5月，采用椎管扩大减压后行TLIF，对常规TLIF技术进行改良，治疗腰椎退行性疾病25例共29个节段，男17例，女8例；年龄24—65岁，平均54．6岁。Ⅰ～Ⅱ度退行性腰椎滑脱症11例，腰椎间盘突出症伴节段不稳6例，腰椎管狭窄症8例。改良方法首先切除一侧下关节突、上关节突内上侧部分及棘突与椎板的下1／2部分，将神经根松解、减压，再向对侧扩大减压范围，行对侧神经根减压，椎管减压满意后按照常规方法完成TLIF。[结果]25例均获得随访，时间12个月～32个月，平均18．4个月，无椎弓根钉失败及Cage前、后侧移位。1例术后6个月X线片示Cage轻度下陷；1例术后出现下肢麻木感，2例下肢麻木加重，均为TLIF侧，其中2例于3个月内症状消除，1例稍有改善；术后1年X线片示未愈合2例。根据Denis疼痛分级、JOA评分法，术后平均改善率92％。[结论]改良TLIF扩大了手术适应证，使操作更加简单、安全，并发症减少，选择性用于腰椎退行性疾病的短期疗效满意。[ Objective] To explore the clinical application and result of modified transforaminal lumbar interbody fusion （TLIF） for the treatment of lumbar degenerative disease. [Method] From October 2003 to May 2005,25 patients （29 levels） suffering from lumbar degenerative disease were treated with modified TLIF. The modification included expansile decompression of vertebral canal combination with TLIF and pedicle screw instrumentation. There were 17 males and 8 females with average age of 54. 6 years, ranging from 24 to 65 years. The preoperative diagnosis included lumbar degenerative spondylolisthesis （ 11 cases, Grade Ⅰ to Ⅱ ）, lumbar intervertebral disc protrusion combined with segmental instability （6 cases ） and lumbar spinal stenosis （ 8 cases） . Expansile decompression of vertebral canal was applied as follows： total inferior facet process and inner half superior facet process of the trouble side were resected firstly, the compression for the nerve root caused by degenerative articular process and lateral recess stenosis was relieved. Then half spinous process and lamina were resected while decompression of the vertebral canal was expanded to opposite side until the never root was decompressed satisfactorily. Care must be taken to avoid over resecting which lead to isthmic breaking. In the end, TLIF was performed according to normal procedure after the decompres- sion of vertebral canal being accomplished. [ Result ] The lateral, AP, flexion - extension X - ray films were taken at 3, 6 months and 1 year after operation to evaluate the fusion, Simmons method and Denis pain measurement and JOA scoring were adopted to determine the results. The intraoperative blood loss ranged from 310 to 820ml （ mean, 530ml）, and total operative time ranged from 110 to 210min （ mean, 165min） . Blood transfusion was carried out in 6 patients （range, 400 to 800 ml） . All patients were followed up for 12 to 36 months （mean, 18.4 months） , no failure of pedicle screws and cage migration occurre

关 键 词：腰椎 退行性疾病 脊柱融合术 改良 减压 

分 类 号：R687.3[医药卫生—骨科学]