改良TLIF治疗腰椎退变性疾病68例临床疗效观察Clinical results of the treatment for lumbar degenerative disease by modified transforaminal lumbar interbody fusion:a follow-up study of 68 cases
吴继彬;郭开今;袁锋;辛兵;冯虎;张新珠;吴东迎;
摘要(Abstract):
[目的]探讨改良经椎间孔椎间融合术(transforaminal lumbar interbody fusion,TLIF)联合椎弓根螺钉内固定治疗下腰椎退行性疾病的手术方法和疗效。[方法]自2009年12月~2014年3月,采用椎管潜行减压改良TLIF手术治疗腰椎退行性疾病68例,男42例,女26例;年龄37~75岁,平均58.6岁;病程10个月~16年。全部行椎弓根钉棒系统内固定、双侧开窗减压术,完整保留棘上韧带、棘间韧带,切除增生的黄韧带及部分增生内聚的小关节突、突出的椎间盘组织,椎间隙以自体骨并单枚Cage融合。术中注意保证棘突、棘上韧带及棘间韧带的完整性。采用视觉模拟法(VAS)疼痛评分和日本矫形外科协会(JOA)评分评估临床疗效,并观察术后并发症情况。[结果]平均手术时间(145±35)min,出血量(650±135)ml,术后伤口引流量(205±24)ml。并发硬脊膜破裂2例,经相应处理后治愈。所有患者随访时间平均15.7个月,术后1个月及末次随访时的腰腿痛VAS评分、JOA评分与术前相比明显降低,差异有统计学意义(P<0.01)。[结论]改良TLIF手术联合椎弓根螺钉内固定治疗下腰椎退行性疾病,具有创伤小、出血少、不破坏对侧结构、手术时间短等优势,并且术后即刻稳定性较常规手术具有明显优势,术后功能恢复满意,是治疗下腰椎退行性疾病的有效方法。
关键词(KeyWords): 下腰椎;退行性疾病;经椎间孔椎间融合术;椎弓根螺钉;内固定
基金项目(Foundation):
作者(Author): 吴继彬;郭开今;袁锋;辛兵;冯虎;张新珠;吴东迎;
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DOI:
参考文献(References):
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