小切口TLIF结合单侧钉棒及对侧关节突螺钉治疗腰椎退变性疾病

Small Incision Transforaminal Interboby Fusion Combined with Unilateral Pedicde Screw and Contra-lateral Translaminal Screw in Treatment of Lumbar Degenerative Diseases

目的探讨小切口经椎间孔椎间融合术（transforaminal lumbar interbody fusion,TLIF）辅助单侧钉棒及对侧经椎板关节突螺钉治疗腰椎退变性疾病手术方法及疗效。方法 2010年1月至2012年6月对我院收治的50例腰椎退行性变（腰椎失稳、单侧症状腰椎管狭窄症及腰椎间盘突出症）患者,均采用单侧TLIF椎间植骨融合、辅助同侧钉棒及对侧经椎板关节突螺钉治疗。采用单侧长4~6cm的旁正中椎旁切口,钝性分离最长肌和多裂肌间隙并显露关节突,直视下症状侧腰椎管减压,椎间盘摘除,置入椎弓根螺钉并Cage植入、对侧经椎板关节突螺钉等操作。结果患者手术时间为100~160min,平均125min,出血量160~330mL,平均250mL。术后平均引流量40mL,无血肿及术后感染、无硬脊膜撕裂、神经根损伤等严重并发症发生。所有病例获得8~24个月（平均19个月）随访,未发现继发性脊柱侧弯,无椎弓根钉、螺钉松动、断裂等情况。患者术后症状均得到明显缓解,并且在随访期间内没有新的临床症状出现。在固定融合后3~18个月取出内固定钉棒后3~6个月,采用日本骨科学会评分（JOA）评价疗效,优35例（70%）,良13例（26%）,可2例（4%）,效果优良。结论小切口单侧TLIF椎间植骨融合、辅助单侧钉棒及对侧经椎板关节突螺钉治疗腰椎退变性疾病能有效固定融合并预防邻近上下节段退变,具有对入路软组织创伤小、术中出血量少、患者术后手术部位疼痛轻、术后恢复快、并发症少、疗效确切的优点,值得临床推广应用。

Objective To explore the effect of small incision transforaminal interbody fusion（TLIF）combined with unilateral pedicle and contralateral translaminar facet screw to treat lumbar degenerative disease.Methods During January 2010to June 2012in our hospital.50cases of lumbar degenerative（lumbar instability,unilateral symptoms of lumbar spinal stenosis and lumbar disc herniation）,treated with unilateral TLIF interbody fusion,auxiliary ipsilateral pedicle screw and contralateral translaminar facet screw fixation.We adopted unilateral paravertebral incision of 4~6cm, and exposed facet gap,symptoms sidelumbar canal decompression under direct vision,dissectomy,implant pedicle screws and Cage,the contralateral translaminar facet screw and other operations.Results Patients operation time was 100~160mins（average 125mins）and bleeding volume was 160~330mL（average 250mL）.The mean postoperative drainage olume 40mL,there were no hematoma and postoperative infection,no dural tear,no nerve root damage and other serious complications.All patients were followed up for to 24months（mean 19months）.3to 18months after operation.We romoved screw and rod fixation.Acorrding to Japanese Orthopaedic Association score（JOA）,there were excellent in 35cases（70%）,mean in 2cases（4%）the rusult was good.Conclusion Small incision unilateral TLIF interbody fusion,auxiliary unilateral pedicle and contralateral translaminar facet screw is a good treatment lumbar degenerative disease.