改良TLIF联合单侧椎弓根钉内固定治疗腰椎间盘突出症  

Treatment of Lumbar Intervertebral Disc Herniation with Modified Transforaminal Lumbar Interbody Fusion Combined with Unilateral Pedicle Screw Fixation

作　　者：吴继彬[1] 郭开今[1] 袁锋[1] 辛兵[1] 冯虎[1] 张新珠[1] 吴东迎[1] 

机构地区：[1]徐州医学院附属医院骨科,江苏徐州221006

出　　处：《实用骨科杂志》2015年第7期581-584,603,共5页Journal of Practical Orthopaedics

摘　　要：目的探讨改良经椎间孔椎间融合术（transforaminal lumbar interbody fusion,TLIF）联合单侧椎弓根螺钉内固定治疗腰椎间盘突出症的手术方法和疗效。方法自2010年12月至2014年4月,采用改良TLIF手术治疗腰椎间盘突出症患者62例,其中采用单边固定28例,双边固定34例。单边固定组：男19例,女9例;年龄28~57岁,融合节段：L1~21例,L2~31例,L3~42例,L4~518例,L5S16例。双边固定组：男22例,女12例;年龄32~59岁,融合节段：L1~21例,L2~32例,L3~43例,L4~519例,L5S19例。分析两组患者的手术时间、术中出血量、术后引流量。采用疼痛视觉模拟量表（visual analogue scale,VAS）评分、日本骨科学会（Japanese orthopaedic association,JOA）评分和Oswestry功能障碍指数（Oswestry disability index,ODI）来评估两组患者的临床效果,并观察术后并发症情况。结果所有患者随访时间平均为16.7个月,单边组的手术时间、出血量和术后引流量明显少于双边组,差异有统计学意义（P〈0.05）。两组内术后VAS评分、ODI评分和JOA评分与术前比较差异有统计学意义（P〈0.01）,但两组之间的各评分比较差异无统计学意义（P〉0.05）。结论改良TLIF手术联合单侧椎弓根螺钉内固定治疗腰椎间盘突出症,具有创伤小、出血少、不破坏对侧结构、手术时间短等优势,术后功能恢复满意。Objective To explore the clinical application and result of modified transforaminal lumbar interbody fusion（ TLIF） with unilateral pedicle screw fixation for the treatment of lumbar intervertebral disc herniation. Methods From December 2010 to April 2014,62 patients with lumbar intervertebral disc herniation were treated by modified TLIF. There were 28 patients in unilateral fixation group,19 males and 9 female,aged from 28 to 57 years old. Fusion located in L1 ~ 2in 1 case,L2 ~ 3in 1 case,L3 ~ 4in 2 cases,L4 ~ 5in 18 cases,L5S1 in 6 cases. There were 34 patients in bilateral fixation group,including 22 males and 12 females,aged from 32 to 59 years old. Fusion located in L1 ~ 2in 1 cases,L2 ~ 3in 2 cases,L3 ~ 4in 3 cases,L4 ~ 5in19 cases,L5S1 in 9 cases. Operation time,intraoperative blood loss,postoperative drainage were analyzed between two groups.The clinical outcomes of 2 groups were assessed by visual analog scale（ VAS） scores,Oswestry and Japanese Orthopedic Association（ JOA） scores. Post-operative complicaions were monitored. Results All patients were followed-up for 16. 7 months,operation time,blood loss and postoperative drainage of unilateral group reduced significantly compared with bilateral fixation group（ P〈0. 05）. In addition,statistical significance was found with respect to postoperative scores of VAS scores,ODI and JOA scores compared with preoperative data（ P〈0. 01）,whereas no statistical significance between the two groups（ P〈0. 05）. Conclusion The modifled TLIF with unilateral pedicle screw fixation for the treatment of lumbar intervertebral disc herniation is an effective method,which has not only some traditional advantages,such as smaller trauma,less bleeding,no destruction of the contralateral structures,short operation time,but also more satisfactory function recovery.

关 键 词：腰椎间盘突出症 经椎间孔椎间融合术 椎弓根螺钉 内固定 

分 类 号：R681.53[医药卫生—骨科学]