椎板关节突螺钉椎间融合术治疗下腰椎退行性疾病

Transforaminal lumbar interbody fusion with translaminar facet screw fixation in treatment of lumbar degenerative disk disease

目的探讨椎板关节突螺钉(TLFS)结合单侧椎弓根螺钉固定椎间融合术微创治疗下腰椎退行性疾病的临床疗效。方法 2009年1月—2011年12月35例单节段下腰椎退行性疾病的患者,采用单侧椎弓根螺钉固定结合对侧椎板关节突螺钉经椎旁肌间隙入路行腰椎间融合术。并于术前、术后1 d、术后3、6、12月及末次随访时采用腰腿痛VAS和ODI量表进行疼痛和功能评分,观察并记录手术时间、术中出血量、切口长度、术后下地时间、住院时间、并发症发生和融合情况等临床结果。结果至术后末次随访时腰腿痛VAS评分及ODI功能评分均较术前明显改善,差异均具有统计学意义(F=61.59,189.22,49.92,P<0.05)。平均随访时间(18.0±6.2)月,根据Bridwell椎间融合评价标准,至末次随访时Ⅰ级21例(60%),Ⅱ级14例(40%),无患者为Ⅲ级和Ⅳ级。有2例(5.7%)术中出现硬膜撕裂,表面覆盖纤维蛋白胶和明胶海绵后,术后没有出现脑脊液漏;1例(2.8%)术后出现切口脂肪液化,积极换药处理后愈合良好,无医源性神经损伤、内固定松动、移位、断裂等相关并发症发生。结论单侧椎弓根螺钉结合对侧TLFS固定椎间融合术治疗下腰椎退行性疾病具有微创、恢复快、融合率高、费用低、稳定性好等优点,只要适应证选择正确,手术效果较为理想,具有良好的临床应用推广价值。

Objective To investigate the utility of transforaminal lumbar interbody fusion（TLIF） using unilateral pedicle screws and translaminar facet screw（TLFS） in the treatment of low lumbar degenerative disk disease （DDD）. Methods From January 2009 to December 2011,35 patients with single-level low lumbar degenerative disease were treated with uni- lateral pedicle screws combined with contralateral TLFS fixation through the approach between multifidus and longissimus muscle. Clinical outcomes were assessed in terms of lower back and leg pain visual analogue scale（ VAS）, Oswestry disa- bility index（ODI） at before surgery and 1 day,3 months,6 months,12 months after surgery and final follow up. The out- comes of operation time, intraoperative blood loss, postoperative bedtime, hospitalization time and fusion rate were also be recorded. Results The postoperative VAS and ODI scores were much better than the preoperative outcomes at the final follow up, the difference were statistically significant （ F = 61.59,189.22,49.92, P 〈 O. 05 ）. The mean follow up was （ 18.0 ＋ 6.2） months, at the end of follow up, all patients achieved solid fusion according to the criteria of Bridwell. Dis- tinct dura laceration was observed during the operation in 2 patients, there was no evidence of cerebrospinal fluid leakage after operation since they were filled with fibrin glue and gelatin sponge. Fatty fluidization was observed in one patient, and was healed by proper treatment. There was no iatrogenic nerve injury and significant failure of implantation during the fol- low up. Conclusion Low lumbar degenerative disk disease can be treated with TLIF technique using unilateral pedicle screws and TLFS,the advantage including less invasion , quickly recovery ,highly fusion rate and lowly cost of implant. It is worthwhile spreading and applying for the TLIF technique using unilateral pedicle screws and a TLFS, as long as the proper surgery indications were chosen.