单侧椎弓根固定经椎间孔椎体间融合术治疗下腰椎退行性疾病  

Unilateral instrumented transforaminal lumbar interbody fusion in low lumbar degenerative diseases

作　　者：贾其余 俞宇 王林[1] 郭万根[1] 胡联英[1] 程晓东[1] 

机构地区：[1]合肥市第二人民医院骨科,安徽合肥230011

出　　处：《临床骨科杂志》2014年第4期377-380,共4页Journal of Clinical Orthopaedics

摘　　要：目的：评价单侧椎弓根固定经椎间孔腰椎椎体间融合术（ TLIF）治疗下腰椎退行性疾病的疗效。方法采用单侧TLIF术治疗41例下腰椎退行性疾病患者,均为单节段手术。观察手术时间、术中出血量及并发症情况。采用腰痛和腿痛视觉模拟评分（ VAS）与Oswestry功能障碍指数（ ODI）评价临床效果,并通过影像学检查对椎体间融合情况进行评价。结果41例均获随访,时间24～9（38±6）个月。手术时间80～180（125±10）min,术中出血量100～550（310±30）ml。手术切口均一期愈合。腰痛VAS分值由术前的（6.5±2.1）分下降至末次随访时的（2.3±0.9）分（P＜0.01）,腿痛VAS分值由术前的（7.6±2.3）分下降至末次随访时的（1.2±0.8）分（P＜0.01）,ODI由术前的54.2±10.9下降至末次随访时的13.8±2.1（P＜0.01）。末次随访融合率为95%,未发现继发性脊柱侧弯、螺钉松动、断裂及Cage移位等情况。结论单侧TLIF术可有选择地治疗下腰椎退行性疾病,其疗效确切,并具有创伤小、手术时间短、出血少、并发症少等优点。Objective To investigate the effect of unilateral instrumented transforaminal lumbar interbody fusion （ TLIF） in the treatment of low lumbar degenerative diseases. Methods 41 patients with low lumbar degenerative diseases in single segment were treated with unilateral pedicle screw fixation TLIF. Operative time, intraoperative blood loss and complications were observed. The visual analogue scale （ VAS ） and the Oswestry disability index （ ODI） were used to evaluate clinical effect, and radiographic parameters were used to evaluate the fusion rates. Re-sults All cases were followed up for 24～59（38 ±6）months. The operative time was 80～180（125 ±10）min, the intraoperative blood loss was 100～550（310±30） ml. All incisions healed by first intention. The lumbar pain VAS scores dropped from 6. 5± 2. 1 preoperatively to 2. 3 ± 0. 9 at final followed-up （P 〈0. 01）, the limb pain VAS scoresdroppedfrom7.6±2.3preoperativelyto1.2±0.8atfinalfollowed-up（P〈0.01）,theODIdroppedfrom 54. 2 ±10. 9 preoperatively to 13. 8 ± 2. 1 at final followed-up （ P〈0. 01 ） . The spine fusion rate was 95% at final followed-up. No loosening, breakage of instrumentation and displacement of cage were observed during followed-up. Conclusions Unilateral instrumented TLIF is acceptable for low lumbar degenerative diseases, the effect is reliable. This method have advantages as minimal invasiveness, less operation time, less bloos loss, and less complications.

关 键 词：腰椎退行性疾病 经椎间孔椎体间融合术 脊柱融合术 

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