经椎间孔入路腰椎椎体间融合术治疗腰椎退变性疾病

Lumbar degenerative disease treated by transforaminal lumbar interbody fusion

目的探讨经椎间孔入路腰椎椎体间融合术(TLIF)治疗腰椎退变性疾病的临床疗效。方法对60例腰椎退变性疾病的患者行TLIF,术前、术后6个月,术后5年采用视觉模拟评分(VAS)对腰背、下肢疼痛进行评估;采用Oswestry功能障碍指数(ODI)对腰椎功能进行评价。测量术前、术后6个月、术后5年手术节段椎间隙前后缘高度、前凸角以及活动度,综合评价手术疗效。结果患者切口均一期愈合,无一例发生脊髓损伤、脑脊液漏或内固定装置移位、脱出等并发症。出现3例神经根牵拉伤,经保守治疗后完全恢复正常。术后6个月、5年随访时腰背、下肢VAS、ODI均较术前明显减少(P<0.05),椎间高度、角度均较术前明显增加(P<0.05);术后6个月与术后5年的ODI、VAS、椎间高度、角度比较差异均无统计学意义(P>0.05);椎间融合率均为100%。结论 TLIF治疗腰椎退变性疾病可维持固定节段的椎间高度与稳定性,达到满意的椎间融合率,近、中期临床效果满意,远期效果有待于进一步临床观察。

Objective To investigate the clinical outcomes of transforaminal lumbar interbody fusion（ TLIF） for lumbar degenerative disease. Methods 60 patients with lumbar degenerative disease were treated with TLIF. The preand post-operative outcomes were assessed by visual analogue scale（ VAS） and Oswestry disability index（ ODI）. The trailing edge height of intervertebral space,segmental lordotic angle and lumbar range of motion were observed and compared before operation,6 months and 5 years after operation respectively. Results Wound were healed smoothly in all patients,and there were no complications such as spinal cord injury,cerebrospinal fluid leakage,device displacement and device dislocation. There were 3 cases with nerve root impingement in TLIF,who recovered well after conservative treatment. All cases were followed up for 5 years. Compared with the preoperative,the VAS and ODI scores in 6 months and 5 years after operation were significantly decreased（ P〈0. 05）,and the trailing edge height of intervertebral space,segmental lordotic angle and lumbar range of motion were significantly increased（ P〈0. 05）.There were no significant difference in VAS,ODI,the trailing edge height of intervertebral space,segmental lordotic angle and lumbar range of motion between 6 months and 5 years after operation（ P〉0. 05）. The spinal fusion of all patients was 100%. Conclusions TLIF in the treatment of lumbar degenerative disease can maintain the height and stability of the intervertebral space of operative segment,and promote spinal fusion. The short- and middle-term efficacy is satisfactory; the long-term efficacy needs to be observed further.