改良TLIF治疗腰椎管狭窄症

Modified transforaminal lumbar interbody fusion for treatment of lumbar spine stenosis

[目的]探讨改良经椎间孔椎间盘切除椎体间融合术(mTLIF)治疗腰椎管狭窄症手术疗效。[方法]2015年12月~2017年1月,本科采用改良TLIF治疗老年退变性腰椎管狭窄症患者68例,其中,男41例,女27例,年龄65~81岁,平均(68.37±6.30)。采用VAS及ODI评价腰椎功能改善情况;应用SF-36量表对生活质量进行调查评估。拍摄腰椎正侧位X线片。[结果]本组患者手术顺利,平均手术时间(120.59±28.46)min、平均术中失血量(254.57±42.87)ml。其中,68例患者中64例(94.12%)获得12个月以上的随访。患者ODI评分由术前(55.32±8.29)分减少至末次随访时的(23.23±5.34)分,差异有统计意义(P<0.05);VAS评分由术前(8.50±0.92)分减少至末次随访时的(1.93±0.75)分,差异有统计学意义(P<0.05)。SF-36评分由术前(463.91±40.18)分增加至末次随访时的(783.11±37.93)分,差异有统计学意义(P<0.05)。[结论]改良TLIF手术入路操作相对简单、有效,术中神经损伤的风险也较小,能彻底减压,同时能获得满意的稳定性和骨性融合。

[Objective]To investigate the clinical outcomes of modified transforaminal lumbar interbody fusion(TLIF)for degenerated lumbar spine stenosis in the elderly.[Methods]From December 2015 to January 2017,68 patients,including 41males and 27 females aged 65~81 years with a mean of(68.37±6.30)years,underwent the modified TLIF in our department.The clinical outcomes were assessed using the visual analogue scale(VAS)for pain,Oswestry disability index(ODI)and Medical Outcomes Study Short Form Health Survey(SF-36).In addition,imaging studies were conducted.[Results]All patients received a successful operation with operation time of(120.59±28.46)min and intraoperative blood loss of(254.57±42.87)ml on average.Of them,64 patients(94.12%)were followed up for more than 12 months.The ODI score significantly decreased from(55.32±8.29)preoperatively to(23.23±5.34)at the latest follow up(P<0.05),consistently,the VAS score significantly reduced from(8.50±0.92)before operation to(1.93±0.75)at the last interview(P<0.05).By contrast,the SF-36 score significantly increased from(463.91±40.18)preoperatively to(783.11±37.93)at the latest follow up,with a statistically significant difference(P<0.05).[Conclusion]The modified TLIF take advantages of relatively simple surgical approach,effective decompression accompanied with satisfactory retention of spine stability and facilitating bony fusion for treatment of lumbar spinal stenosis.