微创TLIF手术的手术方法和早期临床结果

Microinvasive TLIF: Surgery Method and Early Oinical Outcome

目的:探讨对退行性的腰椎病变的病人在小切口的微创入路下,完成改良了经椎弓根的椎体间融合(TLIF)手术。方法:前瞻分析了5例(3男,2女)微创TLIF手术。通过双侧旁正中小切口(约4 cm长),经骶棘肌,行椎板减压,关节突切除,椎体间融合(通过切除双侧关节突及椎间盘后,在所需融合的间隙置入椎间融合器及自体骨)。病人的平均年龄为53．6岁。结果:5例病人中2例是行L5-S1融合,3例为L4-L5融合。平均随访时间为9．1周,所有病人融合情况良好。Oswestry功能障碍指数(ODI)评分从手术前的32．6提高到手术后的43．8。结论:微创TLIF手术是一种安全、有效的技术,并且能够得到良好的手术效果。这种创伤小、暴露好的入路,适合于打入椎弓根钉,置入椎间融合器。还适合于再次手术的病人,这种方法可以避开前次手术的瘢痕,避免神经的损伤。

Objective：The advantage of transforaminal lumbar interbody fusion （TLIF） techniques in patients with degenerative spinal disorders has become increasingly clear. With the increase in popularity of this treatment, a variety of techniques have been used to achieve the goal of anterior column support, fusion, and segmental instrumentation. We evaluated a modification to complete the TLIF in minitrauma technique. Methods：A retrospective analysis was performed in 5 patients （2women, 3 men） who underwent mini TLIF surgery. The approach involved a bilateral mini insection（about 4 cm long on each side）, laminectomy and inferior facetectomy at the level of fusion. The interbody fusion was achieved from this bilateral approach by performing discectomy, artbrodesis, and insertion of one or two titanium cages packed with autologous bone. The average age of the patients in this study was 53. 6 years. Results： Two patients bad L5-S1 TLIF. The rest of the patients had L4-L5 TLIF. The average follow-up time was 9. 1 weeks. All 5 patients bad solid fusions. The Oswestry Disability Index（ODD was rose from the average 32. 6 pre-operation to 43.8 pro-operation. Conclusion：Mini TLIF is a reliable and safe technique for interbody support that can be performed with excellent clinical outcome. In the authors＇ experience, Mini TLIF offers excellent exposure with minimal risk. This applies particularly in cases of repeat spine surgery, in which the presence of scar tissue makes traditional posterior lumbar interbody fusion techniques difficult or impossible. In addition, TLIF seems to be a viable alternative to anteroposterior circumferential fusion and/or anterior lumbar interbody fusion.