TLIF技术在腰椎手术中的应用

TLIF Technique in lumbar surgery

目的探讨经椎间孔入路的腰椎间盘摘除椎间融合技术(TLIF)在腰椎手术中的应用范围和优缺点。方法自2000年以来应用TLIF技术完成各种腰椎手术214例,其中男146例,女68例;初次手术173例,椎间盘突出术后复发41例;上位椎间盘突出(胸_(12)腰_1、腰_(1-2)、腰_(2-3))的65例,下位椎间盘突出(腰_(3-4)、腰_(4-5)、腰_5骶_1)的149例;应用早期枢法模的标准的TLIF钛网式双Cage进行操作78例,应用单Cage进行操作136例。结果所有病例未出现手术造成的神经根和脊髓损伤的症状,亦未出现脑脊液漏及对侧神经根的刺激症状,随访1年X线片及CT显示197例患者获得椎间融合,17例患者因出现椎间盘炎、植骨量吸收等因素出现骨融合欠佳,随访3年后前方形成骨桥,椎间融合器未见下沉现象。随访1至8年未出现断钉和断棒现象。症状缓解情况:依据Oswestry评分平均由术前的10±1分,术后1周为3±1分,1年复查时为1±1分。结论TLIF技术可适用于各节段的中央型或单侧包括极外侧型腰椎间盘突出症,可减少对无症状侧神经根的激惹和椎小关节的破坏,对于高位椎间盘突出可避免发生脊髓损伤,二次椎间盘突出的患者,可防止经瘢痕区进入造成不必要的脑脊液漏和神经根损伤的现象,融合率高。

Objective To investigate the scope of application, advantages and disadvantages of transforaminal lumbar interbody fusion （TLIF） in lumbar surgery. Methods The TLIF technique was used in the lumbar surgeries for 214 cases, who were 146 male and 68 female. A total of 173 cases underwent primary surgery; 41 had recurrence after lumbar disc herniation （LDH）. A total of 65 cases had higher level LDH（T12L1, L1-2, L2-3）, while 149 had lower level LDH（L3-4, L4-5, L5S1）. The classic Metronic double titanium mesh cage was used in the surgery for 78 cases and the single cage was used on 136 cases. Results All cases showed no sign of nerve root injury, spinal cord injury, the leakage of cerebrospinal or irritation of lateral nerve root. X-ray and CT images of one-year follow-up demonstrated 197 cases achieved interbody fusion, and 17 did not achieve good fusion due to discitis or absorption of the graft bone, After 3 years of follow-up, bone bridge was form in the anterior, and the interbody fusion cage did not sink. No screw or rod broke during 1 to 8 years of follow-up. The Oswestry score was 10±1 averagely pre-operatively, 3±1 one week after surgery, and 111 one year after surgery. Conclusions TLIF technique can be used to treat the disc herniation in the middle, lateral or far lateral position. It can reduce the irritation on the asymptomatic nerve root and the damage to the facet joints. It can avoid spinal cord injury for patients with higher level disc protrusion, and avoid the leakage of cerebrospinal and nerve damage caused by entry via the scar zone. It has higher interfusion rates.