改良经椎间孔椎体间融合术治疗腰椎退行性疾病.docVIP

　　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（transforaminal lumbar interbody fusion，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］To explore the clinical application and result of modified transforaminal lumbar interbody fusion (TLIF) for the treatmentof lumbar degenerative disease. ［Method］ From October 2003 to May 2005, 25 patients(29 levels) suffering from lumbar degenerative disease odified TLIF. The modification included expansile depression of vertebral canal bination entation. There ales and 8 females 24 to 65 years. The preoperative diagnosis included lumbar degenerative spondylolisthesis (11 cases, GradeⅠtoⅡ),lumbar intervertebral disc protrusion bined ental instability (6 cases ) and lumbar spinal stenosis ( 8 cases). Expansile depression of vertebral canal ina ust be taken to avoid over resecting ic breaking. In the end, TLIF ed according to normal procedure after the depression of vertebral canal bEing acplished. ［Result］The lateral, AP, flexion-extension X-ray films onths and 1 year after operation to evaluate the fusion, Simmons method and Denis pain measurement and JOA scoring ine the results. The intraoperative blood loss ranged from 310 to 820ml (mean, 530ml), and total operative time ranged from 110 to 210min (mean, 165min). Blood transfusion l). All patients onths (mean, 18.4 months), no failure of pedicle screigration occurred .One cage subsidence and 2 nonunion s,3 patients plained of bness in legs in side ed. The rate of improvement ethods. ［Conclusion］The modified