改良TLIF技术结合椎间植骨融合内固定术治疗脱出型腰椎间盘突出症并椎间不稳

IMPROVED TECHNOLOGY COMBINED WITH TLIF INTERBODY FUSION AND INTERNAL FIXATION TO TREAT PROLAPSE DYPE LUMBAR DISC HERNIATION AND INTERVERTEBRAL INSTABILITY

目的：探讨应用改良TLIF技术结合后路经椎弓根钉棒内固定、椎间融合器（BAK）植骨融合术治疗脱出型腰椎间盘突出症并腰椎不稳症。方法：应用改良TLIF技术结合后路椎弓根钉棒椎间融合器植骨融合术治疗65例腰痛并单侧下肢根性疼痛的脱出型腰椎间盘突出症并腰椎不稳症病人,术前和术后对病人进行视觉疼痛评分（visual analogue pain score,VAS）,椎间系角度、整个腰椎前凸角度、椎间隙后缘高度测量和手术满意度问卷调查,评价治疗效果。结果：随访12~36mo,平均22mo。术前VAS和椎间系角度整个腰椎前凸角度椎间隙后缘高度,分别是7.8±1.8分和3.4±0.3°、40±0.6°、8±0.5mm,随访时为2.9±1.2分（P=0.0082,P〈0.01）和12.6±0.4°（P=0.0075,P〈0.01）、52°±0.5°（P=0.0061,P〈0.01）、12±0.3mm（P=0.0054,P〈0.01）。65例病人中60例手术满意度问卷调查高于40分（92.3%）认为手术效果优良。没有发生因操作不当及器械问题引起的并发症。结论：后路改良TLIF技术结合经椎弓根钉棒内固定、椎间融合器植骨融合术是一种安全有效的治疗脱出型腰椎间盘突出症并腰椎不稳症的手术方法。

Objective： To investigate the application of improved technology TLIF combined passing pedicle screw fixation,interbody fusion（ BAK） to treat prolapse of lumbar disc herniation and lumbar instability. Methods： Application of improved technology TLIF combined with posterior pedicle screw and interbody fusion and fusion treat 65 cases of low back pain and radicular pain with unilateral lower limb prolapse of lumbar disc herniation and lumbar instability patients,the patients were examined visual analogue pain score（ VAS） before and after operation,to survey department of intervertebral angle,the whole lumbar lordosis angle,the edge of the disc space height measurement and surgical satisfaction,to evaluate the therapeutic effect. Results： To follow-up 12 ~ 36 mo,22mo average. VAS before operation and the department of intervertebral angle,whole lumbar lordosis angle and Intervertebral height of the trailing edge,respectively,7. 8 ± 1. 8 points and 3. 4 ± 0. 3°,40 ± 0. 6°,8 ± 0. 5 mm,the first check： 2. 9 ± 1. 2 points（ P = 0. 0082,P〈0. 01） and 12. 6 ± 0. 4°（ P = 0. 0075,P〈0. 01） 、52° ±0. 5°（ P = 0. 0061,P〈0. 01）,12 ± 0. 3mm（ P = 0. 0054,P〈0. 01）. Among 65 patients,60 cases surgery satisfaction survey more than 40 points（ 92. 3%）,and they considered excellent surgical results.Complication of improper operation and Equipment problems didn＇t happen. Conclusion： posterior improved technology TLIF combines with the pedicle screw fixation、interbody fusion and fusion surgery is a safe and effective surgical methods to treat Prolapse Dype Lumbar Disc Herniation and lumbar instability.