经椎间孔腰椎间融合单侧固定对融合节段对侧结构的影响  

Effects on the opposite structures of the minimally invasive transforaminal lumbar interbody fusion and unilateral fixation

作　　者：陈刚[1] 李方财[1] 陈其昕[1] 

机构地区：[1]浙江大学医学院附属第二医院骨科,杭州310009

出　　处：《中华骨科杂志》2011年第10期1083-1087,共5页Chinese Journal of Orthopaedics

基　　金：浙江省卫生厅科研基金（2008A096）

摘　　要：目的研究微创经椎间孔椎体间植骨融合单侧内固定手术对融合节段对侧结构的影响，并探讨术后对侧发生疼痛的原因。方法回顾性分析2009年1月至2010年1月进行微创经椎间孔减压椎体间植骨融合单侧内固定手术的34例患者。使用疼痛视觉模拟评分（visual analogue scale，VAS）和日本整形外科学会（Japanese Orthopaedic Association，JOA）腰椎评分评估疗效，并通过CT检查分析手术对融合节段对侧结构的影响。同时对术后发生对侧疼痛患者的CT资料进行分析，以初步探讨疼痛发生的原因。结果术后患者VAS评分和JOA腰椎评分均较术前显著改善（P〈0．01）。随访中，4例患者术后出现手术对侧腰骶部疼痛。CT显示：L4.5节段手术患者，融合节段手术对侧的腰椎前凸和椎间隙高度的恢复差于手术侧；手术过程中被融合椎体间发生相对旋转。在术后发生对侧腰痛的4例患者中更明显，其中1例患者术后对侧小关节突关节形态发生明显改变。结论经椎间孔椎体间融合单侧固定术后，对侧腰椎前凸和椎间隙高度恢复不足、融合椎体相对旋转及对侧小关节突关节形态的改变，均可能与对侧疼痛的发生相关。Objective To investigate the changes of the opposite structures with the minimally invasive transforaminal lumbar interbody fusion and unilateral fixation. Methods From January 2009 to January 2010, a total of 34 patients with low back pain underwent the minimally invasive transforaminal lumbar inter- body fusion and unilateral internal fixation were retrospectively analyzed. Visual analogue scale （VAS） and Japanese Orthopaedic Association （JOA） low back pain scores were used to assess the outcome of the surgery. All patients were followed up for at least 6 months after surgery. The opposite structures of the segments with fusion and unilateral fixation were investigated with CT scans. CT imaging of the patients with op- posite low back pain after surgery were analyzed for exploring possible causes of the pain. Results There were significant differences between the pre- and post-operation in VAS and JOA scores （P〈0.01）. Four patients met pain in the opposite lumbosacral area after surgery. The CT scans showed that the rebuilding of the lordosis and disc height of the opposite side were more difficult. Rotation could happen in the progress of surgery. For the 4 patients with opposite low back pain after surgery, the insufficiency of the rebuilding of lordosis and disc height of the opposite side, and the rotation between the vertebras were more obvious, and changes were observed in the opposite facet joint on the post-operational CT scan of one patient. Conclusion The minimally invasive transforaminal lumbar interbody fusion and unilateral fixation are effective for patients with low back pain. It＇s important to pay more attention to the rebuilding of the lordosis and disc height of the opposite side, and the rotation of the vertebras in the surgery.

关 键 词：脊柱融合术 外科手术 微创性 腰痛 放射摄影术 

分 类 号：R687.3[医药卫生—骨科学]