经双侧椎间孔椎体间融合治疗腰椎不稳症  

Treatment of lumbar instable disorders by transforaminal lumbar interbody fusion with pedicle screw system

作　　者：张亚军[1] 方礼明[1] 符波[1] 李兵[1] 张树喜[1] 郑继元 李勤[2] 

机构地区：[1]武警北京总队第二医院骨科,北京100037 [2]北京积水潭医院脊柱外科,北京100035

出　　处：《武警医学》2009年第12期1069-1072,共4页Medical Journal of the Chinese People's Armed Police Force

摘　　要：目的探讨腰椎不稳症的诊疗要点和经双侧椎间孔椎体间融合治疗的临床效果。方法采用经双侧椎间孔椎体间融合术(Transfomminal lumbar interbody fusion,TLIF)治疗伴有双侧神经症状的腰椎不稳症患者共38例,其中男26例,女12例,年龄29～63岁,平均48岁,病程2～18年,平均4.5年。结果5例患者术后2周内症状有所反复,所有患者均未出现严重并发症。患者术后3个月症状稳定。术后3个月时VAS和ODI评分分别为(2.1±0.6)分和(13.2±4.1)分,与术前比较差异有统计学意义(P<0.05);VAS评分改善率为(83.9±6.4)%,ODI评分改善率为(70.3±3.2)%。术后12个月内椎体间均骨性融合,融合率100%。疗效评价:优27例,良8例,可3例,优良率92.1%。结论经双侧椎间孔椎间融合术是治疗伴双下肢症状的腰椎不稳症的一种有效方法,需要术前检查与临床症状密切结合制定具体手术方案。Objective To discuss the key issues in the diagnosis and treatment of lumbar instable disorders and the therapeutic effect of transforaminal lumbar interbody fusion on it. Methods 38 cases of lumbar instable disorders with both lower extremities symptom were treated by transforaminal lumbar interbody fusion,including 26 males and 12 females with the age of 29 -63 years. The course of the disease was 2 - 18 years. All patients had received normal conventional treatment for at least 3 months and had no therapeutic effect before operation. Results The symptom in 5 cases was worse than in preoperative, then recovered in two weeks. There was no severe complication. The symptom were kept stably after three months. After 3 months postoperatively, the score of VAS was （2.1±0.6） and the score of ODI was （ 13.2 ±4. 1 ） , indicating there was significant difference in comparison with postoperative ones （ P 〈 0.05 ）. The improvement rates of postoperative VAS and ODI were （ 83.9 ±6.4） % and （70.3 ±3.2 ） % , respectively. All patients got lumbar interbody bone fusion 12 months after operation with the fusion rate of 100%. For the therapeutic effect, 27 cases were regarded as excellent, 8 good, 3 fair and the choiceness rate was 92.1%. Conclusions Transforaminal lumbar interbody fusion is effective for the treatment of lumbar instable disorder.

关 键 词：经椎间孔椎体间融合术 腰椎手术 腰椎不稳症 

分 类 号：R681.53[医药卫生—骨科学]