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1、Short-TermResultsofTransforaminalLumbarInterbodyFusionUsingPedicleScrewwithCorticalBoneTrajectoryComparedwithConventionalTrajectoryDepartmentofOrthopedicSurgery,AkitaUniversityGraduateSchoolofMedicine,Akita,Japan使用皮质骨螺钉植入与传统螺钉植入在TLIF手术中的短期结果Introduction前言Theclinicalresultsoftransforaminallumbarin
2、terbodyfusion(TLIF)havebeenfavorablefordegenerativespondylolisthesis,kyphoscoliosis,andinstabilityofthelumbarspine.However,therehasbeenconcernregardingpediclescrewplacementduringTLIF。TLIF手术的临床效果已经被很好的运用于腰椎退变性滑脱、脊柱侧后凸畸形及腰椎不稳。然而，TLIF手术过程中已经有关于椎弓根螺钉的定位。Exposurelateraltothefacetjointtoinsertapedicles
3、crewrequiresarelativelylongincisionandmuscledissection,whichmayberelatedtopostoperativelowbackpainfrominjurytotheposteromedialbranchofthenerverootcrossingthefacetjointanddamagetotheexposedandretractedbackmusculature.Tominimizetheincisionandmuscledissectionandthusreducetheseproblems,TLIFwithminima
4、llyinvasivepediclescrewinsertion(M-TLIF)andTLIFwithpercutaneouspediclescrewinsertion(P-TLIF)havebeendeveloped.暴露侧方到关节突关节去植入椎弓根螺钉需要相当长的切口和肌肉切开。这种手术因损伤穿过关节突的神经根后支及暴露过程中损伤背肌肉组织而引起后背痛。通过缩小切口及减少肌肉组织的剥离去减少这些问题，TLIF用于微创椎弓根螺钉植入和经皮椎弓根螺钉植入已经被很好的运用。However,severalclinicalconcerns,suchaslowbackpain,learningc
5、urve,radiationexposure,andincorrectpediclescrewplacement,havealsobeenassociatedwithM-TLIFandP-TLIF。然而，在M-TLIF及P-TLIF手术中，几个临床上关注点诸如下腰痛，长的学习曲线，射线的暴露，以及椎弓根螺钉位置植入不正确也已经被证实发生。Anewtrajectoryforpediclescrewinsertionofpediclescrewplacement,thecorticalbonetrajectory(CBT),wasreportedbySantonietal.in2009and
6、mayaddresstheseproblems.Thenewtrajectorywasfrommedialtolateralandcranialtocaudal;thisdoesnotrequirewideexposureofthebackmuscleandthusreducesoperativeinvasioncomparedwithconventionalorpercutaneouspediclescrewinsertion.在2009年，一种新的全皮质椎弓根螺钉植入方法被Santoniet等报道，并且可能解决一些问题。新的全皮质螺钉植入是从内向外，从头向尾，这种方法与传统或者经皮椎
7、弓根螺钉植入相比不需要广泛剥离后背肌肉组织和减少手术损伤However,thedifferencesinoperativeinvasion,accuracyofpediclescrewinsertion,andpostoperativefusionratebetweenTLIFwithCBT(CBT-TLIF)andothermethodsofpediclescrewplacement,suchasM-TLIFandP-TLIF,r
