经椎间孔腰椎体间融合术在腰椎翻修术中的应用  

USING OF TRANSFORAMINAL LUMBAR INTERBODY FUSION IN LUMBAR REVISION SURGERY

作　　者：郝永宏[1] 邓树才[1] 李建江[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》2011年第1期87-90,共4页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的探讨应用经椎间孔腰椎椎体间融合术(transforaminal lumbar interbody fusion,TLIF)治疗腰椎术后失败综合征(failed back surgery syndrome,FBSS)的临床效果。方法 2003年10月-2007年12月,应用TLIF治疗36例腰椎FBSS患者。男19例,女17例;年龄46～68岁,平均52.6岁。病程3个月～15年,平均1.6年。2次手术者25例,3次手术者10例,5次手术者1例。共融合50个节段,其中L4、512例,L5、S110例,L3、4和L4、5双节段8例,L4、5和L5、S1双节段6例。术前常规行腰椎正侧位和屈伸动力位X线片、CT及MRI检查,诊断为腰椎全椎板减压术后继发腰椎不稳12例,腰椎间盘突出症术后复发18例,腰椎滑脱术后复发6例。结果 1例术中发生硬膜破裂,经缝合修补,术后无脑脊液漏发生。1例术后1周发生切口深部金黄色葡萄球菌感染,1例术后3d因切口形成血肿出现一过性单根刺激症状,经对症治疗均治愈;其余患者切口均Ⅰ期愈合。无永久性神经损伤或症状加重者。33例获随访,随访时间18～72个月,平均35.2个月。术后12个月患者均达椎间融合,无螺钉断裂和椎间融合器移位、沉陷。术前日本骨科协会(JOA)评分为(14.2±4.1)分,术后18个月为(23.9±2.6)分,差异有统计学意义(t=2.45,P=0.01)。临床效果评价获优23例,良7例,可3例,改善率为90.9%。结论应用TLIF技术治疗腰椎FBSS,简化了腰椎翻修手术的操作环节,降低了手术危险,减少了术后并发症。Objective To analyze the effectiveness of transforaminal lumbar interbody fusion（TLIF） for failed back surgery syndrome（FBSS）.Methods Between October 2003 and December 2007,36 patients with FBSS were treated with TLIF.There were 19 males and 17 females with an average age of 52.6 years（range,46-68 years） and an average disease duration of 1.6 years（range,3 months-15 years）.Of 36 patients,reoperation was performed in 25,10 received 3 operations,and 1 had 5 operations.A total of 50 segments were involved in fusion,including L4,5 in 12 cases,L5,S1 in 10 cases,L3,4 and L4,5 double segments in 8 cases,and L4,5 and L5,S1 double segments in 6 cases.According to X-ray films,CT,and MRI examination,12 patients were diagnosed as having lumbar instability secondary to total laminectomy,18 as having recurrence of lumbar disc protrusion,and 6 as having recurrence of lumbar spondylolisthesis.Results Dural rupture occurred in 1 case and was repaired by suturing without cerebrospinal fluid leakage was observed;1 had deep incision infection of Staphylococcus;and 1 had transient single irritation sign because of hematoma formation and was cured after symptomatic treatment.The other incisions healed by first intention.No patients had permanent nerve injury or deterioration.Thirty-three cases were followed up 18-72 months（mean,35.2 months）.At 12 months,all the operated segments reached interbody fusion,and no breakage of screw or Cage dislocation occurred.Japanese Orthopaedic Association（JOA） scores showed significant difference（t=2.45,P=0.01） between before operation（14.2± 4.1） and 18 months after operation（23.9± 2.6）.The rate of clinical improvement was 90.9%（23 cases of excellent,7 cases of good,3 cases of acceptable）.Conclusion The TLIF simplifies the manipulation of lumbar revision surgery and decreases the operation risk and the operative complications for the treatment of FBSS.

关 键 词：经椎间孔腰椎椎体间融合术 腰椎术后失败综合征 翻修术 

分 类 号：R687.3[医药卫生—骨科学]