TLIF手术在腰椎翻修手术中的应用及疗效评价

Effects of TLIF technique in lumbar revision surgery

目的采用经椎间孔腰椎椎体间融合术（TLIF）对需要翻修的腰椎术后患者进行治疗并评价其疗效。方法回顾性分析自2008-02—2012-06采用TLIF手术治疗腰椎术后需要翻修的患者26例的临床资料。结果所有患者获得随访12-42（18.2±3.2）个月;JOA评分术前为（12.05±1.50）分,术后1年为（24.35±2.53）分,ODI评分术前为（31.26±2.45）%,术后1年为（6.08±3.25）%,术前与术后1年比较差异有统计学意义（P〈0.01）;根据改善率评估优良率为92.3%。椎间高度术后（11.5±1.5）mm与术前（8.0±1.8）mm比较,差异有统计学意义（P〈0.05）;椎间高度术后1年（11.4±1.3）mm与术后比较,差异无统计学意义（P〉0.05）;总体融合率为100%。结论 TLIF有利于翻修手术的操作,术中、术后伴随可治愈性的并发症如硬膜撕裂、术后神经根性疼痛、术区肿胀,其近期疗效可靠。

Objective To selectively apply TLIF technique in the lumbar revision surgery and subsequently to evaluate its effects. Methods From February 2008 to June 2012, 26 cases which accept operation and appeared revision indication were re-operated with TLIF technique. The clinical results were analyzed retrospectively. Results All patients were followed up for 12-42（18.2±3.2）months. JOA score was（12.05±1.50）preoperatively and（24.35±2.53） 12 months after operation. ODI score was（31.26 ±2.45）% preoperatively and（6.08 ±3.25）% 12 months after re-operation. The two score system showed statistical significance before and 12 months after revision operation（P〈 0.01）. The excellent and good rate was 92.3% which based on improvement rate calculation. The average intervertebral height changed from（8.0 ±1.8）mm preoperatively to（11.5 ±1.5）mm postoperatively, while（11.4 ±1.3）mm when followed up more than 12 month after revision-operation. It showed significant difference compared before and after revision, same as to compared it with the final follow up which was performed more than 12 months（P 〈0.05）, but no significant difference compared between the two latter（P 〉0.05）. The fusion rate was 100% observed on dynamic X-ray photo. Conclusion TLIF can facilitate operation procedures with dependable effect, fewer curable complications such as dural tear and cerebrospinal fluid leakage, nerve root pain and wound swelling occurred in or after the revision surgery.