改良经椎间孔椎体间融合术治疗腰椎退行性疾病【临床专业医学论文设计】.doc

《改良经椎间孔椎体间融合术治疗腰椎退行性疾病【临床专业医学论文设计】.doc》由会员上传分享，免费在线阅读，更多相关内容在工程资料-天天文库。

1、临床医学论文•改良经椎间孔椎体间融合术治疗腰椎退行性疾病【摘要】探讨改良经椎间孔椎体间融合术(transforaminal1umbarinterbodyfusion，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度退行性腰椎滑脫症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

2、神经根松解、减压，再向对侧扩大减压范围，行对侧神经根减压，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

3、性疾病脊柱融合术改良减压Abstract:[Objective]Toexploretheclinicalapplicationandresultofmodifiedtransforaminallumbarinterbodyfusion(TLIF)forthetrealmenlof1umbardegenerativedisease.〔MeIhod〕FromOctober2003toMay2005,25patients(29levels)sufferingfromlumbardegenerativediseaseweretreatedwithmodifiedT

4、LIF.ThemodificationincludedexpansiledecompressionofvertebralcanalcombinationwithTLTFandpediclescrewinstrumentalion.Therewere17malesand8femaleswithaverageageof54.6years,rangingfrom24to65years.Theprcopcrativcdiagnosisincludedlumbardegenerativespondylolislhesis(11cases,GradeItoll),lu

5、mbarintervertebraldiscprotrusioncombinedwithsegmentalinstabi1ity(6cases)and1umbarspinalstenosis(8cases).Expansiledecompressionofvertebralcanalwasappliedasfollows:totalinferiorfacetprocessandinnerhalfsuperiorfacetprocessofthetroublesidewereresectedfirstly'thecompressionforthenerver

6、ootcausedbydegenerativearticularprocessandlateralrecessstenosiswasrelieved.Thenhalfspinousprocessandlaminawereresectedwhi1edecompressionofthevertebralcanalwasexpandedtooppositesideunti1theneverrootwasdecompressedsatisfactori1y.Caremustbetakentoavoidoverresectingwhichleadtoisthmicb

7、reaking.Intheend,TLIFwasperformedaccordingtonormalprocedureafterthedecompressionofvertebralcanalbeingaccomplished.〔Result〕Thelateral,AP,flexioextensionX-rayfilmsweretakenat3,6monthsand1yearafteroperationtoevaluatethefusion,SimmonsmethodandDenispainmeasurementandJOAscoringwereadopt

8、edtodeterminetheresults.Theintrao