经椎间孔腰椎椎体间融合术的早中期疗效

Early and mid-term outcomes of unilateral transforaminal lumbar interbody fusion

目的探讨经椎间孔腰椎椎体间融合术（transforaminal lumbar interbody fusion，TLIF）治疗腰椎运动节段疼痛的早中期疗效。方法回顾性研究156例行TLIF患者的临床及影像学资料。男73例，女83例；平均年龄52．8岁。共175个融合节段，包括L,22个，L2，33个，L3，417个，L4,587个，L5S166个。术后平均随访25．4个月。影像学评价包括融合率、椎间盘后高及腰椎运动节段前凸角；临床疗效评价包括改良Prolo功能评分、疼痛视觉类比评分（visual analogue scale，VAS）及患者满意度指数。结果本组融合率为90．9％，术后椎间盘高度、运动节段前凸角较术前显著改善（t=3．200，P=0．003；t=2．689，P=0．011）。根据改良Prolo功能评分，术后疗效优良率达87．8％，融合组的优良率显著高于不融合组（χ^2=6．943，P=0．021）。VAS术后较术前显著降低（t=3．636，P=0．001），融合组术后VAS显著低于不融合组（t=2．391，P=0．022）。患者术后满意率仅为78．8％，腰痛组满意率显著低于下肢痛组（χ^2=4．532，P=0．025）。术后14例出现并发症，仅2例为严重并发症。结论TUF手术可安全应用于腰椎所有节段的融合，具有较高的融合率，能有效恢复运动节段椎间高度及腰椎前凸，但多数患者术后仍残留不同程度的症状。椎体间坚强融合与手术疗效有关，术中对融合区域软骨终板的清除不彻底以及椎体间植骨量的不足是导致融合失败的主要原因。

Objective To investigate the outcomes of unilateral transforaminal lumbar interbody fusion（TLIF） to the pain of lumbar motion segment in early and mid-term duration of follow-up. Methods 156 patients performed with TLIF were studied retrospectively. There were 73 males and 83 females, with a mean age of 52.8 years （range 27-76 years）. A total of 175 levels were fused, 2 at the L1,2 level, 3 at L2,3, 17 at L3.4, 87 at L4.5 level and 66 at L5S1. All patients were followed up with a mean duration of 25.4 months （range 12-36 months）. The imaging evaluation included fusion rate, disc posterior height （PH） and lordosis angle （LA） of motion segment. The clinical outcomes included modified Prolo scale, visual analogue scale （VAS） and patient satisfied index （PSI）. Statistical analysis was performed with SPSS 10.0. Results The fusion rate of this series was 90.9%. The PH increased significantly from （5.1±3.3） mm preoperatively to （9.6±3.8） mm at the final follow-up （t=3.200,P=0.003）. There was a significant improvement of LA from 7.5°±6.3° preoperatively to 12.8°±4.9° postoperatively （t=2.689 ,P=0.011 ）. According to the modified Prolo scale, 87.8% of the patients obtained excellent or good result, and there was a significant difference between the fusion group and non-fusion group（χ^2=6.943 ,P=0.021 ）. The VAS decreased significantly from （7.8±2.6） score preoperatively to （3.1±2.9） score postoperatively （t=3.636,P=0.001）, and there was a significant difference between the fusion group and non-fusion group （t=2.391 ,P=0.022）. Only 78,8% of patients were satisfied with their results, and there was a significant difference between the low back pain group and leg pain group （χ^2=4.532,P=0.025）. Twelve patients sustained minor complications, and 2 patients with major complication. Conclusion TLIF is a safe and effective method of achieving lumbar fusion with a high radiographic fusion rate, while maintaining proper disc height and restoring sagittal plane alignment. And a nearly 90% of overall patient obtaining excellent or good result, but frequently results in incomplete relief of symptoms. Solid interbody fusion is responsible for better outcomes, and non-union of interbody fusion mainly come from inadequate bone graft and residual cartilage of end plate.