改良经椎间孔椎体间融合术治疗高位腰椎间盘突出症

Operative treatment of upper lumbar disc herniation with modified transforaminal lumbar interbody fusion

目的:探讨改良经椎间孔椎体间融合术(transforaminal lumbar interbody fusion,TLIF)治疗高位腰椎间盘突出症的手术方法和临床疗效。方法:自2005年6月至2009年6月,采用改良经椎间孔椎体间融合术治疗高位腰椎间盘突出症32例,男21例,女11例;年龄24～59岁,平均38.5岁。采用日本骨科协会(Japanese Orthopedic Associa-tion,JOA)腰椎疾病29分评分法和视觉模拟评分法(Visual Analogue Score,VAS),对总体疗效、症状改善率及疼痛缓解率等进行综合评定。结果:所有患者均获得随访,时间3～18个月,平均9个月,切口均愈合,无感染,无椎弓根钉失败,临床融合率100%;JOA评分由术前(10.5±2.1)分提高至术后随访时(26.2±2.4)分,改善率为84.9%;术前、术后VAS评分分别为7.2±1.3和1.4±1.1,疼痛缓解率80.6%,4例患者有腰部僵硬或不适,2例有明显下肢痛(6.25%),均经非手术治疗,于术后1～8周,疼痛逐渐消失。结论:改良经椎间孔椎体间融合术具有操作简单、安全性高、椎管减压彻底等优点,可用于需椎体间融合的高位腰椎间盘突出症的手术治疗。

Objective：To investigate the surgical methods and clinical results of modified transforaminal lumbar interbody fusion and internal fixation for the treatment of upper lumbar disc herniation. Methods：Clinical data of 32 cases of upper lumbar disc herniation in our department from June 2005 to June 2009 were retrospectively analyzed. There were 21 males and 11 females,the age from 24 to 59 years with an average of 38.5 years. All the cases were treated by the use of nucleus pulposus removed,modified transforaminal lumbar interbody fusion （TLIF） and internal fixation with pedicle screw system. All patients were followed up with an average of 9 months （from 3 to 18 months）,according to Japanese Orthopedic Association （JOA） scores and visual analogue scores （VAS） to evaluate clinical effects. Results：All the cases were followed up from 3 to 18 months with an average of 9 months and the fusion rate was 100%. The JOA sores before and after operation were 10.5± 2.1,26.2±2.4 respectively,and the improvement rate was 84.9%. The VAS before and after operation was 7.2±1.3 and 1.4±1.1 respectively,and the rate of catabatic pain was 80.6%. Lumbar rigidity and unwell had 4 cases,obviously leg pain had 2 cases after operation,but the systems vanished gradually at 1-8 weeks after non operative treatment. Conclusion：Modified transforaminal lumbar interbody fusion has the advantages of simple,safe operation and thoroughly decompression,and it is a therapeutic method for upper lumbar disc herniation.