改良经椎间孔腰椎椎间融合术治疗退变性腰椎滑脱的疗效评价  

Efficacy evaluation of modified transforaminal lumbar interbody fusion for the treatment of degenerative lumbar spondylolisthesis

作　　者：杨家赵[1] 方诗元[1] 王叙进[1] 孙建皖[1] 徐磊[1] 孔荣[1] 

机构地区：[1]安徽医科大学附属省立医院骨科,安徽合肥230001

出　　处：《临床骨科杂志》2014年第2期124-127,共4页Journal of Clinical Orthopaedics

基　　金：安徽医科大学附属省立医院杰出中青年人才培养专项基金(编号:2012204)

摘　　要：目的：评估改良经椎间孔腰椎椎间融合术（TLIF）治疗退变性腰椎滑脱（DLS）的临床疗效。方法采用改良TLIF治疗DLS患者32例。手术前后采用Denis疼痛与工作量表评估临床疗效；测量手术前后的腰椎滑脱率、滑脱角、椎间隙高度和腰椎前凸角，并行影像学评估；采用Macnab标准综合评定优良率。结果32例均获随访，时间2～4（2.8±0.2）年。术后Denis疼痛与工作量表分布较术前明显改善（P＜0.05）。术后2～3 d、3个月、6个月和1年的腰椎滑脱率、滑脱角、椎间隙高度、腰椎前凸角均较术前明显改善（P＜0.05）；术后不同时间点的腰椎滑脱率、滑脱角、椎间隙高度、腰椎前凸角比较差异均无统计学意义（P＞0.05）。术后1年影像学检查见椎间及后侧植骨区成熟骨桥生长。Macnab评定：优14例，良16例，可2例，优良率93.8％。结论改良TLIF治疗DLS具有创伤小，能提供理想的复位、满意的临床疗效和融合率。Objective To evaluate the clinical efficacy of modified transforaminal lumbar interbody fusion （TLIF） for the treatment of degenerative lumbar spondylolisthesis（DLS）. Methods 32 consecutive patients with DLS were trea- ted with modified TLIF. Clinical outcome was assessed by Denis＇ pain and work scale, preoperatively and postopera- tively. Radiologic assessment was done by slip rate, slip angle, intervertebral height and lumbar lordosis angle, pre- operatively and postoperatively. Excellent rate was assessed integratedly using Macnab criteria. Results All patients were followed up for 2. 8± 0.2 years （range, 2 to 4 years）. Denis＇ pain and work scale after operation were signifi- cant different when compared with preoperative ones （P 〈 0. 05）. At 2 - 3 days, 3 months, 6 months and 1 year after operation, the slip rate, slip angle, minimally invasive surgery intervertebral height and lumbar lordosis angle were significantly improved when compared with preoperative ones （ P 〈 0.05）. The slip rate, slip angle, intervertebral height and lumbar lordosis angle showed no significant difference （P 〉 0.05） at different time points after operation. All patients got bone fusion in the intervertebral and posterior region by radiologic film at 1 year after operation. Ac- cording to the Macnab criteria, 14 cases were excellent, 16 good, 1 fair and the excellent and good rate was 93.8%. Conclusions Modified TLIF is little invasive surgery,and it can afford ideal reduction, satisfactory clinical outcome and union rate.

关 键 词：经椎间孔腰椎椎间融合术 提拉复位 退变性腰椎滑脱 椎弓根螺钉 

分 类 号：R681.5[医药卫生—骨科学] R687.3[医药卫生—外科学]