扩大减压的经椎间孔椎间融合术治疗下腰椎疾病的疗效分析  

Efficacy of transforaminal lumbar interbody fusion with enhanced decompression to treat lower lumber spine disease

作　　者：刘日新[1] 李春晓[1] 张志刚[1] 刘万新[1] 陈选明[1] 

机构地区：[1]广东医学院附属陈星海医院骨科,中山528415

出　　处：《国际医药卫生导报》2011年第2期158-161,共4页International Medicine and Health Guidance News

摘　　要：目的 分析用改良的经椎间孔椎体间融合术（TLIF）治疗下腰椎退行性疾病的临床效果.方法 从2005年2月-2009年2月,我科对26例患下腰椎退行性疾病的患者采用椎管扩大减压后行TLIF方法融合固定,术中先切除TLIF侧下关节突、上关节突内上侧部分,并将该椎管节段扩大减压,使硬膜及神经根完全松解,满意后按照常规方法完成TLIF.结果 26例病人均获得随访,时间12～36个月,平均20.6个月,无术口感染,无椎弓根钉松脱、断裂,无Cake移位.1例术后出现下肢麻木疼痛,对症治疗3个月后明显减轻;1例术后18月融合节段未见骨性连接,骨融合率96.2%.椎间隙后缘高度由术前平均（5.12±0.58）mm,术后1周内复查为（9.86±0.71）mm（P〈0.01）,末次随访（9.67±0.69）mm（P〈0.01）.腰椎脊柱前凸得到明显的改善;末次随访时视觉评分,由术前的（7.99±0.74）分改善到（1.95±0.39）分（P〈0.01）.按改良的Prolo功能评分,优14例,良9例,可2例,差1例,优良率88.5%.结论 改良的TLIF方法扩大了手术适应症,使操作更加安全,减少了并发症的发生,用于治疗并发有椎管狭窄及双侧神经根孔狭窄的退行性下腰椎疾病疗效满意.Objective To analyze the clinical effectiveness of modified transforaminal lumbar interbody fusion（TLIF） to treat the lower lumbar retrogression. Methods From Feb. 2005 to Feb.2009,26 cases were treated by TLIF after laminoplasty and decompression, removed the superior articular process and inside and upside part of inferior articular process, enlarged the canal for decompression,released the spinal cord and nerve roots completely. The conventional TLIFs was completed then. Results All the 26 cases were followed up 12 to 36 months, 20.6 months in average. There were no infection,loosening and breakdown of pedicle nails , no movement of Cake. There was numb and pain of lower limbs of 1 case, which was relieved obviously after 3 months of symptomatic treatment, and non-union of fused lumbar of another cases after 18 months. The fusion rate was 96.2%.The height of afterskirt of intervertebral space rised from （5.12 ± 0.58）mm before operation to （9.86 ± 0.71）mm at 1 week after operation, and became （9.67 ± 0.69）mm at the last follow-up（P〈0.01 ）. At the last follow-up, the visual scales of lumbar lordosis were improved to （1.95 ± 0.39） from（7.99 ± 0.74 ）before operation（P〈0.01）. According to modified Prolo functional score, 14 cases were rated as excellent, 9 as good,2 as fair and 1 as poor, the rate of excellence and good was 88.5%.Conclusion The modified TLIF can expand the indication of operation,ensure the operation safer, decease the complication, and be satisfatory to treat the lower lumbar retrogression with spinal stenosis and bilateral intervertebral foramen stenosis.

关 键 词：腰椎 退行性疾患 脊柱融合术 改良 减压 

分 类 号：R687[医药卫生—骨科学]