摘要
Objective： To evaluate the lumbar stability and the primary clinical results of unilateral facetectomy, transforaminal lumbar interbody fusion （TLIF） and unilateral pedicle screw fixation by X-Tube system. Methods： Five human lumbar cadaveric functional spine units（FSU） were obtained and graded facetectomy by 0, 1/4, 1/2, 3/4 and 4/4 were performed respectively on the left articular process of them. The stability of these 5 models was evaluated at flexion, extension, lateral bending and axial rotation. After a serial of biomechanical researches, 23 patients from June 2004 to March 2006 in our department underwent unilateral facetectomy, transforaminal lumbar interbody fusion （posterior lumbar interbody fusion） and unilateral pedicle screw instrumentation by X-Tube system. After general anaesthesia, with the guide of fluoroscopy and using X-Tube system, procedures of unilateral endoscopic facetectomy, spinal nerve root decompression, autologus spongy bone transplantation, one cage oblique insertion and unilateral pedicle screw instrumentation were performed. Results： There was no significant difference in flexion, extension, lateral bending and axial rotation of lumbar motion range after unilateral graded facetectomy. The stability of left/right axial direction was greatly affected when the range of graded facetectomy exceed 1/2. According to the Nakai criteria, for the 23 patients, the clinical result was excellent in 15 （65.2%）, good in 6 （26.1%） and fair in 2 （8.7%）. The fusion rate was 95.6% in excellent and good cases. Although partial absorption of bone grafts was observed in 1 case which might indicate a unsuccessful fusion, there was no loosing and replacement of instrument and no clinical symptoms occurred. Conclusion： The lumbar stability will be affected significantly when the range of graded facetectomy exceeds 1/2. Procedures of unilateral facetectomy, transforaminal lumbar interbody fusion and unilateral pedicle screw fixation is an optional strategy for microsurgical reconstruction, though the indications of the procedure should be carefully restricted.
评估腰部的稳定性和单方的 facetectomy 的主要临床的结果的目的， transforaminal 腰部的 interbody 熔化(TLIF ) 和由 X 试管的单方的小花梗螺丝钉固定系统。方法五人的腰部的 cadaveric 功能的脊骨单位(FSU ) 被 0 获得并且分级 facetectomy， 1/4， 1/2， 3/4 和 4/4 在他们的左关节的过程上分别地被执行。这 5 个模型的稳定性在屈曲，延期，侧面的弯曲和轴的旋转被评估。在 biomechanical 研究的一个连续剧以后，到在我们的部门的 2006 年 3 月的从 2004 年 6 月的 23 个病人经历了单方的 facetectomy， transforaminal 腰部的 interbody 熔化(以后的腰部的 interbody 熔化) 和由 X 试管的单方的小花梗螺丝钉乐器学系统。在一般麻醉以后，与荧光检查并且用 X 试管系统的指南，单方的内视镜的 facetectomy 的过程，针的神经根解压缩， autologus 多孔的骨头移植，一个笼子倾斜的插入和单方的小花梗螺丝钉乐器学被执行。在那里的结果不是在屈曲，延期，在单方的分级的 facetectomy 以后的侧面的弯曲和腰部的运动范围的轴的旋转的重要差别。当时，左 / 权利的轴的方向的稳定性极大地被影响分级的 facetectomy 的范围超过 1/2。根据 Nakai 标准，为 23 个病人，临床的结果在 15 是优秀的(65.2%) ，在 6 好(26.1%) 并且在 2 的交易会(8.7%) 。熔化率在优秀、好的盒子中是 95.6% 。尽管骨头接枝的部分吸收在可能显示失败的熔化的 1 种情况中被观察，没有松开，仪器和没有临床的症状的代替发生了。当分级的 facetectomy 的范围超过 1/2 时，腰部的稳定性将显著地被影响的结论。单方的 facetectomy 的过程， transforaminal 腰部的 interbody 熔化和单方的小花梗螺丝钉固定是为 microsurgical 重建的可选的策略，不过，过程的指示应该小心地被限制。
