小关节分级切除在经椎间孔入路椎间融合术的临床应用

Application of graded facetectomy in transforaminal lumbar interbody fusion

目的探讨小关节分级切除应用于经椎间孔入路椎间融合术的临床疗效。方法回顾分析本组应用自外而内的小关节分级切除、实施经椎间孔入路椎间融合手术的57例患者。通过影像学手段、疼痛视觉模拟量表(visual analog scale,VAS)评分、中华骨科学会脊柱学组腰背痛手术评分标准评估患者术前、术后及随访时的情况,并进行统计学分析。结果所有患者无内固定松动、脱落、移位等并发症发生;术后1例出现切口感染,抗感染治疗2周后痊愈;VAS评分改善明显(P<0.05);按中华骨科学会脊柱学组腰背痛手术评分标准,手术优良率为93%。所有患者术后3个月均达到骨性融合。结论在一定适应证下,自外而内的分级切除小关节的减压方案用于经椎间孔入路椎间融合术是可行、安全、有效的。

Objective To explore the clinical outcome of transforaminal lumbar interbody fusion with graded facetectomy. Methods A total of 57 cases accepting transforaminal lumbar interbody fusion with graded facetectomy were retrospectively analyzed. Imaging examinations, visual analog scale （VAS）, and the standard scoring system of Chinese Spinal Association were used for investigation. Data was collected preoperatively and at 3 postoperative follow-up time points, and then were statistically analyzed. Results No internal fixation failure was observed. Incision infection was noted in 1 patient who got cured after 2 weeks antibiotic therapy. VAS score improved significantly （P 〈 0.05 ）. The satisfactory rate was 93%. All the patients got bony fusion 3 months after operation. Conclusion In selected cases, outside-in graded facetectomy applied in intransforaminal lumbar interbody fusion is feasible, safe and effective.