显微镜下微创经椎间孔椎体间融合术治疗伴腰椎不稳的椎间盘突出症

Treatment for lumbar disk herniation accompanied by instability with transforaminal lumbar interbody fusion method under microscope

目的探讨显微镜下经椎间孔椎体间融合术(TLIF)治疗伴腰椎失稳的椎间盘突出症的手术方法。方法18例患者在显微镜辅助下实施微创TLIF手术,手术中各植入融合器1枚。观察随访12～15个月,平均13.6个月。采用JOA评分对手术效果进行评价,并记录手术时间和手术出血量,观察术后有无融合器松动、下沉以及椎间隙感染等情况。结果平均手术时间158±45min,手术出血量123±65ml。术前JOA评分11.5±2.2,术后JOA评分22.5±3.5,与术前比较差异有统计学意义(t=3.221,P=0.006),手术改善率88.9%。未出现融合器移位、下沉以及椎间隙感染等并发症。结论与传统的切开减压内固定手术比较,显微镜下微创TLIF手术具有手术切口小、手术减压彻底、术后恢复快、疗效好等特点,是治疗椎间盘突出症伴腰椎不稳的有效方法。

Objective To investigate a method for treatment of lumbar disk herniation accompanied by instability with minimally invasive transforaminal lumbar interbody fusion （TLIF） under microscope. Methods Eighteen patients who received TLIF under microscope had been implanted with the new designed cage. The mean follow-up period was 13.6 months （range 12-15 months）. The clinical functional results were evaluated according to JOA scores, and the mean operation time and the mean blood lose volume were measured. The loosening or subsidence for cage and gap infection were also observed. Results The mean operation time was 158 - 45 min, the mean blood lose volume was 123 - 65 ml, the preoperative JOA scores were 11.5 - 2.2 and postoperative JOA scores were 22.5 ± 3.5 respectively, which improved significantly （t =3.221, P =0.006）. The improvement rate was 88.9%. There were no patients with loosening, subsidence for cage and gap infection. Conclusion Minimally invasive TLIF under microscope is an effective method for lumbar disk herniation with the advantage of invasive incision, thorough decompression, quick rehabilation and good result which is superior to traditional open surgery.