单侧微创经椎间孔腰椎椎体间融合内固定治疗腰椎退变性疾病

Unilateral minimally invasive transforaminal lumbar interbody fusion for degenerative lumbar diseases

目的探讨采用单侧微创经椎间孔腰椎椎体间融合(minimally invasive transforaminal lumbar interbody fusion,MiTLIF)内固定治疗腰椎退变性疾病的临床效果。方法 2009年1月～2011年4月采用微创单侧椎弓根钉棒联合单Cage固定经椎间孔腰椎椎体间融合术治疗表现为单侧下肢神经根症状的腰椎退行性变患者36例,观察手术时间、术中出血量及并发症发生情况,影像学观察椎间隙高度及椎间融合情况,采用疼痛视觉模拟量表(visual analoguescale,VAS)评分和日本骨科学会(Japanese Orthopaedic Association,JOA)评分评估临床效果。结果 36例患者平均手术时间为90 min;术中平均出血量为150 mL。3例出现并发症,硬脊膜撕裂2例,术中予以修补,其中1例出现脑脊液漏,经对症处理术后6 d内脑脊液漏停止;1例术后出现神经缺失症状加重,通过及时血肿清除、神经根减压后损伤症状消失。所有患者平均随访18.6个月。末次随访矢状面X线片示椎间隙高度从术前(5.78±1.92)mm增至(10.35±1.21)mm,椎间融合率为94.4%。末次随访腰痛VAS评分及腰腿痛VAS评分与术前相比显著改善,差异有统计学意义(P<0.01),JOA改善率为84.4%。结论单侧MiTLIF内固定治疗腰椎退变性疾病对腰椎后部结构破坏小,术中出血少,椎间隙高度恢复满意,并发症发生率低,手术疗效好,是一种有效的治疗方法。

Objective To evaluate the clinical outcomes of unilateral minimally invasive transforaminal lumbar interbody fusion（MiTLIF） for degenerative lumbar diseases.Methods From January 2009 to April 2011,36 patients with degenerative lumbar diseases combined with unilateral lower extremity radicular symptoms underwent MiTLIF.Operation time,blood loss and complications were recorded.Intervertebral height and fusion rate were observed by radiographic data.Visual analogue scale（VAS） and Japanese Orthopaedic Association（JOA） scores were used for clinical assessment.Results The average operation time was 90 min and average intraoperative blood loss was 150 mL in the 36 patients.Complications were noted in 3 patients.Spinal dura matter tearing occurred in 2 patients and was repaired during the operation;of them,one had leakage of cerebrospinal fluid,which ceased 6 d after symptomatic treatment.Nerve root irritation developed postoperatively in one patient and was resolved after evacuation of hematoma and decompression.The mean follow-up was 18.6 months.X-ray films at the final follow-up showed that the intervertebral height increased from preoperative（5.78±1.92） mm to postoperative（10.35±1.21） mm and the fusion rate was 94.4%.The VAS scores of low back pain and leg pain were significantly decreased at the final follow-up,and the differences between preoperative and the final follow-up VAS scores had statistical significance（P0.01）.The improvement rate of JOA was 84.4%.Conclusion With little disorganization of posterior lumbar vertebra,less intraoperative blood loss,satisfactory intervertebral height recovery and low incidence rate of complications.Unilateral MiTLIF is an effective method for degenerative lumbar diseases.