改良TLIF入路椎体间单侧单枚融合器植骨结合椎弓根钉系统内固定治疗多节段腰椎管狭窄症合并腰椎不稳  

Modified TLIF approach of unilaterally single cage bone grafting combined with pedicle screw internal fixation system for the treatment of multi-segmental lumbar spinal canal stenosis and lumbar instability

作　　者：汤长华[1] 张晓慧[1] 周晓宇[1] 赵曙[1] 张杰[1] 张坡[1] 纪兆亮[1] 朱冬承[1] 曹晓建[2] 

机构地区：[1]江苏省泗洪县人民医院骨科,泗洪县223900 [2]江苏省人民医院骨科,南京市201129

出　　处：《微创医学》2014年第1期15-17,27,共4页Journal of Minimally Invasive Medicine

基　　金：江苏省社会发展项目(合同号:BE2010743)

摘　　要：目的 评价改良经椎间孔椎体融合术（transforaminal lumbar interbody fusion,TLIF）入路椎体间单侧单枚融合器植骨结合椎弓根钉系统内固定治疗多节段腰椎管狭窄症及腰椎不稳的疗效.方法 多节段腰椎管狭窄症及腰椎不稳患者31例,其中 L1～S1 2例,L2～5 5例,L2～S1 2例L3～S1 9例,L4～S1 13例.腰椎不稳、滑脱部位：L1～5 2例,L2～4 5例,L2～5 2例,L3～5 9例,L4～5 13例.峡部裂性滑脱12例（外伤性2例）,退变性滑脱19例.采用改良TLIF入路椎管减压、GSS或SINO内固定装置复位内固定、椎体间混合植骨、单侧单枚cage治疗.分析术后症状、体征改善情况.结果 按侯树勋等制定的疗效评定标准评定疗效：优26例,良5例,31例均获满意复位,椎间植骨融合良好.按日本骨科协会（JOA）下腰痛疾患疗效评定,改善率达90%～98%（平均96%）.结论 应用改良TLIF入路椎体间单侧单枚融合器植骨结合椎弓根钉系统内固定治疗多节段腰椎管狭窄症并腰椎不稳,具有减压彻底、固定稳定、微创植骨易融合、神经副损伤少等优点,是治疗多节段腰椎管狭窄症及腰椎不稳的理想方法.Objective To evaluate the efficacy of the modified transforaminal lumbar interbody fusion（TLIF） approach of unilaterally single cage bone grafting combined with pedicle screw internal fixation system in the treatment of multi-segmental lumbar spinal canal stenosis and lumbar instability. Methods Thirty-one cases of multi-segmental lumbar spinal canal stenosis and lumbar instability were treated with decompression of the modified TLIF approach, internal fixation device fixation of GSS or SINO, interbody mixed bone graft, and unilateral single cage. Lesions were located in L1-S1 in 2 cases,L2-5 in 5 cases, L2-S1 in 2 cases, L3-S1 in 9 cases, and L4-S1 in 13 cases. Lumbar instability or slippage site was in L1-5 in 2 cases, L2-4 in 5 cases, L2-5 in 2 cases, L3-5 in 9 cases, and L4-5 in 13 cases. There was isthmic spondylolisthesis in 12 cases （2 cases of traumatic）, and degenerative spondylolisthesis in 19 cases. Postoperative improvements in symptoms and signs were analyzed. Results The results were excellent in 26 cases, and good in 5 cases according to the Hou Shu-xun formulation of the evaluating standard of curative effect evaluation of curative effect.All 31 cases were with satisfactory reduction, and good interbody fusion The improvement rate ranged from 90% to 98% （average, 96%） according to Low Back Pain Disease Curative Effect of Japanese Orthopaedic Association.Conclusion Modified TLIF approach of unilaterally single cage bone grafting combined with pedicle screw internal fixation system has such merits as complete decompression, stable fixation, minimally invasive bone grafting, easy fusion, and less nerve injury,etc., indicating it as an ideal method in the treatment of multi-segmental lumbar spinal canal stenosis and lumbar instability.

关 键 词：椎管狭窄症 腰椎不稳 内固定 植骨 

分 类 号：R687.3[医药卫生—骨科学]