改良经椎间孔椎体间融合术治疗腰椎退行性疾病

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1、改良经椎间孔椎体间融合术治疗腰椎退行性疾病.L.编辑。【摘要】探讨改良经椎间孔椎体间融合术（transforaminallumbarinterbodyfusion，TLIF)用于腰椎退行性疾病的手术方法及疗效。［方法］2003年10月～2005年5月，采用椎管扩大减压后行TLIF，对常规TLIF技术进行改良,治疗腰椎退行性疾病25例共29个节段，男17例，女8例；年龄24～65岁，平均54.6岁。Ⅰ～Ⅱ度退行性腰椎滑脱症11例，腰椎间盘突出症伴节段不稳6例，腰椎管狭窄症8例。改良方法首先切除一侧下关节突、上关节突内上侧部分及棘突与椎板的下1/2部分，将神经根松解、减压，再向对侧扩大减压范围，行

2、对侧神经根减压，椎管减压满意后按照常规方法完成TLIF。［结果］25例均获得随访，时间12个月～32个月，平均18.4个月，无椎弓根钉失败及Cage前、后侧移位。1例术后6个月X线片示Cage轻度下陷；1例术后出现下肢麻木感，2例下肢麻木加重，均为TLIF侧，其中2例于3个月内症状消除，1例稍有改善；术后1年X线片示未愈合2例。根据Denis疼痛分级、JOA评分法，术后平均改善率92%。［结论］改良TLIF扩大了手术适应证，使操作更加简单、安全，并发症减少，选择性用于腰椎退行性疾病的短期疗效满意。【关键词】腰椎退行性疾病脊柱融合术改良减压Abstract:［Objective］Toexplor

3、etheclinicalapplicationandresultofmodifiedtransforaminallumbarinterbodyfusion(TLIF)forthetreatmentoflumbardegenerativedisease.［Method］FromOctober2003toMay2005,25patients(29levels)sufferingfromlumbardegenerativediseaseodifiedTLIF.Themodificationincludedexpansiledepressionofvertebralcanalbinationentat

4、ion.Therealesand8females24to65years.Thepreoperativediagnosisincludedlumbardegenerativespondylolisthesis(11cases,GradeⅠtoⅡ),lumbarintervertebraldiscprotrusionbinedentalinstability(6cases)andlumbarspinalstenosis(8cases).Expansiledepressionofvertebralcanalinaustbetakentoavoidoverresectingicbreaking.Int

5、heend,TLIFedaccordingtonormalprocedureafterthedepressionofvertebralcanalbEingacplished.［Result］Thelateral,AP,flexion-extensionX-rayfilmsonthsand1yearafteroperationtoevaluatethefusion,SimmonsmethodandDenispainmeasurementandJOAscoringinetheresults.Theintraoperativebloodlossrangedfrom310to820ml(mean,53

6、0ml),andtotaloperativetimerangedfrom110to210min(mean,165min).Bloodtransfusionl).Allpatientsonths(mean,18.4months),nofailureofpediclescreigrationoccurred.Onecagesubsidenceand2nonunions,3patientsplainedofbnessinlegsinsideed.Therateofimprovementethods.［Conclusion］ThemodifiedTLIFexpandstheindicationsfor

7、TLIF.Operativeprocedurecanbeperformedmoreeasilyandsafelyeselectedpatientssufferingfromlumbardegenerativediseaseaccordingtotheauthor’sexperience.Keybarvertebrae；degenerativedisease；spinalfusion；modifie