微创改良经腰椎间孔椎体间融合联合双侧钉棒系统固定治疗腰椎退行性疾病

Minimally invasive improved TLIF combined with bilateral nail rod fixation in the treatment of lumbarvertebrae degenerative disease

目的探讨采用微创（minimally invasive）改良经腰椎间孔椎体间融合（modified transforaminal lumbar in-terbodyfusion,TLIF）联合双侧钉棒系统治疗腰椎退行性疾病（lumbarvertebrae degenerative disease）的适应证、手术方法、初步疗效及并发症。方法 2011年1月-2012年3月,随机选取有微创TLIF术适应证腰椎退行性疾病病例30例,其中微创改良TLIF联合双侧钉捧系统固定组（A组）15例,常规开放TLIF组（B组）15例,行各自术式手术并进行对照研究。结果术后6个月A组同B组在腰椎椎间植骨融合率、JOA评分等方面比较差异均有统计学意义（P〈0.05）。结论微创改良TLIF联合双侧钉捧系统固定治疗腰椎退行性疾病具有软组织损伤小、出血量少,不破坏症状侧对侧正常骨性结构、脊柱的稳定性高,住院时间短,腰椎椎间植骨融合率高,临床症状、体征及括约肌功能改善率高,并发症发生率低等优点,值得在临床推广应用。

Objective To investigate the indications,surgical method,preliminary curative effect and complications of lum barvertebrae degenerative disease treated by minimally invasive improved modified transforaminal lumbar in-terbody fusion（TLIF） combined with bilateral nail rod fixation.Methods From January 2011 to March 2012,30 cases of patients with lumbarvertebrae degenerative disease,who had indication of minimally invasive TLIF,were randomly selected to accept operation and control study.It included minimally invasive improved TLIF combined with bilateral nail rod fixation group（group A） in 15 cases,conventional open TLIF group（group B） in 15 cases.Results Six months after operation,a comparison of lumbar interbody fusion rate and JOA score between group A and group B was statistically significantly different（P〈0.05）.Conclusion The treatment of minimally invasive improved TLIF combined with bilateral nail rod fixation has sev eral advantages,such as minimal soft tissue trauma,less blood loss,no destruction of normal bone structure in the offside of lesion area,high spinal stability,shorter hospitalization time,high lumbar in-terbody fusion rate,high recovery rate of clinical symptoms,signs and sphincter muscle function,low complication rate.So it is worthy of application widely.