单侧经椎间孔椎体间融合术治疗腰椎退变性疾病  

Clinical Outcome of Transforaminal Lumbar Interbody Fusion for Lumbar Degenerative Diseases

作　　者：王进军[1] 林源[1] 苏庆军[1] 海涌[1] 

机构地区：[1]首都医科大学骨外科学系附属北京朝阳医院骨科,北京100020

出　　处：《实用骨科杂志》2010年第10期724-727,共4页Journal of Practical Orthopaedics

摘　　要：目的探讨单侧经椎间孔椎体间融合术治疗腰椎退变性疾病的临床效果。方法 2003年1月至2005年12月,应用经椎间孔椎体间融合术治疗36例腰椎退变性疾病。男22例,女14例;年龄43～66岁,平均55岁。术前诊断:腰椎间盘突出症合并椎管狭窄12例,腰椎间盘切除术后复发4例,腰椎退变性滑脱症8例,腰椎管狭窄症12例。单融合节段:L3～43例,L4～515例,L5S18例;双融合节段:L3～4和L4～54例,L4～5和L5S16例。内植物:椎弓根钉+钛网26例,椎弓根钉+椎间融合器10例。临床疗效应用日本骨科学会下腰痛评分系统(JOA评分)对手术前和末次随访时进行评价。根据JOA评分计算改善率。结果 36例患者均获得随访,随访时间1年8个月至4年9个月,平均3年5个月。术前JOA评分为(6.2±1.3)分,术后JOA评分为(12.6±2.2)分。手术前后JOA评分比较有显著性差异(P<0.05),术后平均改善率为72.7%,临床疗效满意。随访时正侧位X线片显示:40个椎间植骨融合;6个椎间植骨可能融合。并发症1例术中神经根牵拉伤未完全恢复,且术后2年出现伤口深部感染,X线片显示椎体间融合,经清创、取出椎弓根内固定、置管冲洗后治愈。结论单侧经椎间孔椎体间融合术治疗退变性腰椎疾病的临床疗效满意,创伤小,融合率高。Objective To explore the clinical outcome of transforaminal lumbar interbody fusion（TLIF） for lumbar degenerative diseases.Methods From January 2003 to December 2005,36 patients undergone transforaminal lumbar interbody fusion with pedicle screw fixation.22 patients were men and 14 women.The average age was 55 years（range,43 to 66 years）.Preoperative diagnosis included lumbar intervertebral disc heniation with lumbar stenosis（12 patients）,failed lumbar disc excision（4 patients）,lumbar degenerative spondylolisthesis（8 patients）,lumbar stenosis（12 patients）.A single-level fused：L3～43 patients,L4～5 15 patients,L5S1 8 patients;two levels fused：L3～4and L4～5 4 patients,L4～5and L5S1 6 patients.The implant：pedicle screw with Pyramesh 26 patients,pedicle screw with cage 10 patients.The patients was evaluate by the Japanese Orthopedic Association scoring system（JOA score） preoperatively and the final follow-up,and the recovery rate calculated by using JOA score.Results All patients were followed up.The average period of follow-up was 41 months（range,20 to 57 months）.The average preoperative JOA score（15-point system） in 36patients was（6.2±1.3） points,The final follow-up assessment was（12.6±2.2）points,The JOA score was significantly different in preoperatively and in the final（P0.05）.The average recovery rate calculated by the preoperative and the final score was 72.7%.The clinical outcome was satisfactory.40 intervertebral fused and 6 fused probably.1 patient with nerve root impingement of operation didnot recover well and with late deep infection 2 years later treated with debridement,removal of implant and irrigation-suction system inserted healed.Conclusion TLIF for lumbar degenerative diseases demonstrated effective,less invasive,higher fusion rate.

关 键 词：椎体间融合术 腰椎 退变 

分 类 号：R681.57[医药卫生—骨科学]