改良经椎间孔腰椎椎体间融合术在老年退变性腰椎管狭窄症中的应用

The modified transforaminal lumbar interbody fusion for elderly degenerative lumbar spine stenosis

目的探讨改良经椎间孔腰椎椎体间融合术（transforaminal lumbar interbody fusion, TLIF ）在老年退变性腰椎管狭窄症中的应用和效果。方法2009年2月-2012年6月，采用改良TILF治疗退变性腰椎管狭窄症93例，其中男性51例，女性42例，平均年龄（70．3±4．5）岁，随访24m，观察术后并发症，采用视觉模拟评分（Visual analoguescale，VAS）和Oswestry功能障碍指数（Oswestry disability index，ODI）进行临床疗效评估。结果术中出血量（200±25）mL，术后平均住院天数（14±2）d，手术时间（150±20）min。术后12dVAS下降[（7．5±1．1）vs（4．3±1．4），P〈0．01]，ODI下降[（53．9±10．2）％VS（43．5±8．4）％，P〈0．01]。术后随访24m，VAS持续下降至（2．0±0．9），ODI下降至（27．1±7．9）％。椎间植骨获骨性融合率96．8％。结论老年退变性腰椎管狭窄症治疗中神经根管减压是重点，改良TLIF技术治疗退变性椎管狭窄症安全有效。

Objective To investigate the clinical outcomes of elderly patients with degenerated lumbar spine stenosis treated by the modified transforaminal lumbar inerbody fusion. Methods From Feb.2009 to Jun.2012,there were 93 patients [male 51, female 42, mean age （70.3 5±4.5）] from posterior approach, all patients were performed withforaminal stenosis de- compression and posterior oblique lumbar arthrodesis. Clinical outcome was assessed using the Visual Analog Scale, Oswes- try disability index. The follow-up was 24 months. Results The mean estimated blood loss was （200 ±25）mL, the mean length of stay was （14 ±2）days, the mean operative was （150±20）min. At 12 days after operation the mean VAS decreased sig- nificantly [（7.5±1.1） vs （4.3±1.4）, P〈0.001], the mean ODI decreased significantly [（53.9±10.2） % vs （43.5±8.4） %, P 〈 0.001], At 24-month follow-up, the mean VAS score was （2.0 ±0.9）, mean ODI was （27.1±7.9） %. A solid fusion was achieved in 96.8 % patients. Conclusions Nerve decompression is the key in patients with degenerated lumbar spine stenosis The mondified transforaminal lumbar interbody fusion is a sound procedure for the treatment of unstable degeneration with foraminal stenosis of lumbar spine.