后路经椎间孔椎体间融合术的临床应用(附21例报告)

Clinical application of transforaminal lumbar interbody fusion:feport of 21 cases

目的探讨后路经椎间孔椎体间融合术进行腰椎滑脱治疗的效果。方法自2006年5月至2009年5月,对21例(23节段)腰椎滑脱患者进行TLIF手术,患者包括男7例,女14例;年龄42～67岁,平均53.6岁,根据Meyerding分级标准,Ⅰ度滑脱7例,Ⅱ度滑脱14例,术中选择采用SofamorDanek公司TENOR、CDHM8或BASIS内固定系统,SofamorDanek公司TELAMON或钛网,或CAPSTONEPeek材料融合器,术后随访包括JOA腰背痛评分标准评分、常规X线摄片、CT扫描。结果 21例患者平均随访时间26.5个月,无一例出现感染、断钉、椎间融合器下沉、后移等并发症,1例术后出现神经症状,经药物治疗后好转。手术腰椎节段不同程度融合,椎间隙高度、椎体滑移距离、腰椎前突弧度不同程度改善,融合率为90.5,腰背痛评分统计:术前(14.8±4.2)分,术后(24.9±3.5)分,差异有统计学意义(P<0.01)。结论 TLIF是一种安全、有效、微创的技术;CT扫描可以简单、精确评估椎体融合情况。

Objective To investigate the treatment of spondylolisthesis with transforaminal lumbar interbody fusion.Methods From May 2005 to May 2009,21 cases（23 levels） including 7 males and 14 females suffering from spondylolisthesis were treated with TLIF.The average age of the patients in this study was 53.6（from 42 to 47）.In operations internal fixation systems used were TENOR or CDHM8 or BASIS from the Sofamor Danek company,and internal fusion were TELAMON or titanium mesh cage or CAPSTONE Peek from the Sofamor Danek company.The change in the Japanese Orthopedics Association score,the recovery rate,and radiographic findings were evaluated.Results All cases were followed up for 12~47 months（26.5 months on average） with the fusion rate of 90.5%.There were no severe complication except that symptom of nerve injury in one case who recovered after treatment with neurotrophy.Translational distance were restored from（5.9±3.3） mm preoperatively to（2.3±1.6）mm postoperatively.Respectively the JOA scores were（14.8±4.2） points preoperatively,and after surgery increased to（24.9±3.5） points.Conclusion TLIF is a safe and reliable and minimally invasive technique,and CT images are used to evaluate simply and effectively the interbody fusion.