改良经椎间孔腰椎椎体间融合术治疗下腰椎退变性疾患  

MODIFIED TRANSFORAMINAL LUMBAR INTERBODY FUSION FOR THE TREATMENT OF LUMBAR DEGENERATIVE DISEASE

作　　者：李建江[1] 邓树才[1] 赵栋[1] 赵合元[1] 孙志明[1] 郝永宏[1] 马毅[1] 

机构地区：[1]天津医院脊柱外科,天津300211

出　　处：《中国修复重建外科杂志》2009年第7期788-792,共5页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的总结应用改良经椎间孔腰椎椎体间融合术(transforaminal lumbar interbody fusion,TLIF)治疗下腰椎退变性疾患的临床效果。方法2003年10月-2006年12月,应用改良TLIF手术治疗L3～S1退变性患者33例。其中男14例,女19例;年龄33～70岁,平均52.2岁。病程4个月～15年,中位时间1.8年。共融合42个节段,其中单节段24例,双节段9例。退变性滑脱伴椎管狭窄8例,峡不连性滑脱5例,退变性腰椎管狭窄症16例,巨大椎间盘脱出合并椎间失稳3例,腰椎术后失败综合征1例。术中切除整个下关节突,切除上关节突上部的内侧半,部分开放椎间孔后壁,椎间隙内预置自体骨3～5mL,取1枚矩形Cage斜向中线30～40°方向植入椎间隙,辅以椎弓根螺钉固定完成TLIF,根据病情需要同时施以中央管和对侧减压。结果发生术中硬脊膜撕裂、术后脑脊液漏、术后切口深部感染和一过性神经根刺激症状各1例,均经治疗后好转。术后无永久性神经损伤或症状加重患者。33例均获随访,随访时间20～58个月,平均27.2个月。所有患者于术后1年随访时均达椎体间融合,无螺钉断裂和Cage移位沉陷。13例腰椎滑脱者滑脱完全复位并维持良好。根据JOA评分法,术前(14.9±5.1)分,末次随访时(25.9±3.0)分(P<0.05);临床改善程度达优24例,良7例,可2例,平均改善率80.5%。结论改良TLIF手术较传统TLIF简化了操作环节,在一定程度上扩大了适应证,在开放手术中贯彻了微创原则,用于下腰椎退变性疾患的治疗效果满意。Objective To analyze the clinical effects of modified transforaminal lumbar interbody fusion （TLIF） for the treatment of lumbar degenerative disease. Methods From October 2003 to December 2006, 33 patients with lumbar degenerative disease （L3-S1） were treated by modified TLIF. There were 14 males and 19 females with an average age of 52.2 years （33 to 70 years）. The median disease course was 1.8 years （4 months to 15 years）. A total of 42 levels were fused, including 24 cases of single level and 9 cases of double levels. The results of preoperative diagnosis were lumbar degenerative spondylolisthesis with stenosis （8 cases）, isthmic spondylolisthesis （5 cases）, degenerative lumbar stenosis （16 cases）, huge herniated disc with segmental instability （3 cases） and failed back surgery syndrome （1 case）. During the modified TLIF procedure, total inferior facet process and inner half summit of superior facet process of TLIF side were resected to make the posterior wall of foramen opened partly. After the bone graft （3 to 5 mL） was placed into the interbody space, a single rectangle Cage was inserted obliquely from 30° to 40° toward the midline. Combined with pedicle screw instrumentation, TLIF was accomplished. Middle canal and opposite side nerve root decompression were performed simultaneously when necessary. Results Intraoperative dura mater rupture, postoperative cerebral spinal fluid leakage, deep wound infection and transient nerve root stimulation occurred in 1 case respectively, and were all recovered after treatment. No patients had permanent neurologic deficit or aggravation. All patients were followed up for 20 to 58 months （mean 27.2 months）. At the follow-up after i year postoperatively, all the operated segments achieved fusion standard and no broken screw or Cage dislocation occurred. All 13 cases of spondylolisthesis were reduced thoroughly and maintained satisfactorily. Nineteen patients remained slight chronic back pain. There was significant difference �

关 键 词：腰椎 退变性疾病 经椎间孔腰椎椎体间融合术 改良 

分 类 号：R687.3[医药卫生—骨科学]