改良TLIF治疗腰椎退变性疾病68例临床疗效观察

Clinical results of the treatment for lumbar degenerative disease by modified transforaminal lumbar interbody fusion:a follow-up study of 68 cases

[目的]探讨改良经椎间孔椎间融合术（transforaminal lumbar interbody fusion,TLIF）联合椎弓根螺钉内固定治疗下腰椎退行性疾病的手术方法和疗效。[方法]自2009年12月∽2014年3月,采用椎管潜行减压改良TLIF手术治疗腰椎退行性疾病68例,男42例,女26例;年龄37∽75岁,平均58.6岁;病程10个月∽16年。全部行椎弓根钉棒系统内固定、双侧开窗减压术,完整保留棘上韧带、棘间韧带,切除增生的黄韧带及部分增生内聚的小关节突、突出的椎间盘组织,椎间隙以自体骨并单枚Cage融合。术中注意保证棘突、棘上韧带及棘间韧带的完整性。采用视觉模拟法（VAS）疼痛评分和日本矫形外科协会（JOA）评分评估临床疗效,并观察术后并发症情况。[结果]平均手术时间（145±35）min,出血量（650±135）ml,术后伤口引流量（205±24）ml。并发硬脊膜破裂2例,经相应处理后治愈。所有患者随访时间平均15.7个月,术后1个月及末次随访时的腰腿痛VAS评分、JOA评分与术前相比明显降低,差异有统计学意义（P〈0.01）。[结论]改良TLIF手术联合椎弓根螺钉内固定治疗下腰椎退行性疾病,具有创伤小、出血少、不破坏对侧结构、手术时间短等优势,并且术后即刻稳定性较常规手术具有明显优势,术后功能恢复满意,是治疗下腰椎退行性疾病的有效方法。

[ Objective] To study the clinical application of modified transforaminal lumbar interbody fusion （TLIF） and pedicle screw fixation in the treatment of low lumbar degenerative disease. [ Methods] From December 2009 to March 2014, 68 patients with lumbar degenerative diseases were treated by the modified TLIF. It included 42 males and 26 females with an av- erage of 58.6 years old （ranged from 37 to 75） and with the courses of disease ranged from 10 months to 16 years. The proce- dure of operation included the fixation of pedicle screw system, fenestration, preservation of supraspinous and interspinous liga- ment, resection of hyperplastic yellow ligament and facet joint, resection of herniated disc tissue and intervertebral space fusion by single cage. Clinical outcomes were assessed by the VAS scores and JOA scores. Post -operative complications were also ob- served. [ Results] In the all of 68 patients, the average time of operation was （145 ± 35 ） rain, the average amount of blood loss was （650 ± 135） ml and the average amount of post -operative drainage was （205±24） ml. Two patients had the complication of dural tear and were cured later. All patients were followed - up for 15.7 months. The results of VAS scores and JOA scores at one month after operation and last visit were significantly lower than that of pre - operation （ P 〈 0. 01 ） . [ Conclusion ] The modified TLIF with pedicle screw fixation for the treatment of low lumbar degenerative disease is an effective method, which has not only some advantages of traditional treatment, such as smaller injury, less bleeding, no harm to contralateral structures and short time of operation, but also has better initial stability and more satisfactory function recovery..