椎间盘内破裂症的诊断和经椎间孔腰椎间融合术的手术治疗

[目的]探讨椎间盘造影对诊断椎间盘内破裂症的意义和经椎间孔腰椎间融合治疗盘内破裂症的效果。[方法]对25例下腰痛的患者进行椎间盘造影术，诊断椎间盘内破裂症20例，其中18例接受经椎间孔腰椎间融合术。[结果]18例均得到随访，12-24个月，平均16个月，采用Oswestry功能障碍指数评分，术前平均35分，术后12个月平均为12分，融合率100％。无1例发生严重并发症。[结论]椎间盘造影术是诊断椎间盘内破裂症的一种可靠方法，经椎间孔腰椎间融合术治疗盘内破裂症，具有安全、有效，创伤小并且并发症少的优点。     

A meta-analysis comparing ALIF,PLIF, TLIF and LLIF

IntroductionLumbar interbody fusions have been widely used to treat degenerative lumbar disease that fails to respond to conservative treatment. This procedure is divided according to its approach: anterior lumbar interbody fusion (ALIF), posterior lumbar interbody fusion (PLIF), transforaminal lumbar interbody fusion (TLIF) and lateral lumbar interbody fusion (LLIF). Each approach has its own theoretical advantages and disadvantages; however, there have been no studies that compared these.MethodsVarious full-text databases were systematically searched through December 2015. Data regarding the radiological, operative and clinical outcomes of each lumbar interbody fusion were extracted. All outcomes were pooled using random effects meta-analysis, with the relative risk (RR) and/or weighted mean difference (WMD) as the summary statistic.ResultsThirty studies met the inclusion criteria. The ALIF procedure has been studied most intensively, followed by PLIF, TLIF and LLIF respectively. All four approaches had similar fusion rates (p = 0.320 & 0.703). ALIF has superior radiological outcome, achieving better postoperative disc height (p = 0.002 & 0.005) and postoperative segmental lordosis (p = 0.013 & 0.000). TLIF had better Oswestry Disability Index scores (p = 0.025 & 0.000) while PLIF had the greatest blood loss (p = 0.032 & 0.006). Complication rates were similar between approaches. Other comparisons were either inconclusive or lacked data. There was marked less studies comparing against LLIF.ConclusionsEach approach has their own risks and benefits but similar fusion rates. Despite the large number of studies, there is little data overall when comparing specific aspects of lumbar interbody fusions. More studies, especially RCTs are needed to further explore this topic.     

单侧入路双侧减压TLIF手术治疗腰椎管狭窄症的疗效研究

目的 研究单侧入路双侧减压TLIF 手术与传统的PLIF 手术方式相比治疗腰椎管狭窄症的治疗效果。方法 以2016 年10 月～2017 年8 月我院收治的36 例腰椎管狭窄症患者为研究对象,将其随机分为实验组和对照组,其中对照组采用传统的PLIF 手术治疗,实验组采用单侧入路双侧减压TLIF 手术治疗,每组各18 例,比较两组患者的临床疗效及术后康复情况。结果 两组患者的手术时间、术中出血量和住院时间均差异无统计学意义（P>0.05）,但实验组患者的术后引流量更少（P＜0.05）。治疗后两组患者术后第1、3 天的CPK 水平显著高于术前（P＜0.05）,且实验组显著高于对照组（P＜0.05）,但术后第7 天的CPK 水平两组较术前均无统计学意义（P>0.05）。术后3 个月时两组的VAS 评分和ODI 评分均较术前显著下降（P＜0.05）,且实验组明显优于对照组（P＜0.05）。结论 与传统的PLIF 手术方式相比,单侧入路双侧减压TLIF 手术治疗腰椎管狭窄症的疗效更为显著,对于患者造成的手术创伤较小,术后恢复效果更好。     

TLIF术式在布氏杆菌性脊柱炎病人中的临床疗效及安全性分析

目的 对比分析单纯后路内固定+一期经腰椎间孔病椎间病灶清除(TLIF)与经典的前后联合手术在布氏杆菌性脊柱炎患者中的临床疗效及安全性。 方法 对我院2015年1月至2017年12月收治的93例布病性脊柱炎患者的临床资料进行分析。按手术方式分为观察组(45例)和对照组(48例)。对两组患者的基础数据、临床指标、术前术后各项指标水平以及术后并发症、植骨治愈情况。 结果 观察组与对照组基础数据比较,差异无统计学意义(P>0.05)。观察组患者的手术时间、住院天数、术中出血量及术后下床时间均明显低于对照组(P<0.01)。两组患者术后3个月的ODI、VAS、CRP、ESR及Cobb角均明显低于术前(P<0.05);术后3个月,观察组患者的ODI、VAS、CRP、ESR及Cobb角均明显低于对照组(P<0.05)。观察组术后并发症发生率(4.4%)明显低于对照组(25.0%)(Χ²=7.674,P<0.01)。 结论 TLIF治疗布氏杆菌性脊柱炎患者的临床疗效突出,安全性较好,更有利于患者术后身体的恢复。     

Zero通道下MISS TLIF联合Zina钉治疗腰椎间盘突出症

目的探讨Zero通道下微创经椎间孔入路行椎管减压、椎间融合(MISS TLIF)联合Zina钉治疗腰椎间盘突出症的临床疗效。方法对55例腰椎间盘突出症患者采用后路切口经多裂肌肉间隙入路、经Zero通道下行MISS TLIF联合Zina钉技术治疗。其中单侧减压49例,双侧减压5例,单侧入路双侧减压1例。采用Nakai分级评定临床疗效。结果患者均获得随访,时间6~18个月。患者腰痛和下肢放射性麻木等临床症状均有效缓解,临床疗效按Nakai分级评定:优25例,良29例,可1例,优良率为98.18%。结论 Zero通道下MISS TLIF联合Zina钉治疗腰椎间盘突出症能显著缓解患者症状,改善功能,近期疗效好。     

腰椎行椎间孔入路椎间融合术固定的有限元分析

目的 利用有限元方法分析经单侧椎间孔入路腰椎间融合术治疗腰椎退行性病变的临床可行性。方法 基于正常人L3~5节段的CT扫描数据,利用Mimics、Pro/E、ANSYS软件分别建立L3~5正常生理状态有限元模型、L4/5左单侧椎弓根螺钉内固定加椎间融合器模型(单侧TLIF)、L4/5双侧椎弓根螺钉内固定加椎间融合器模型(双侧TLIF)。在L3上表面施加500 N的人体重力和10 N?m力矩,模拟人体直立、前屈、后伸、左侧弯和右旋5种生理活动,观察不同工况时椎体、椎间盘、螺钉及融合器上变形及应力分布情况,比较两种固定方法力学性能上的差异。结果 各种工况下单侧TLIF、双侧TLIF的L3~5节段变形量均较生理状态模型减少,单侧TLIF、双侧TLIF模型均在后伸运动时融合器的应力达到最大值,且单侧TLIF模型椎弓根螺钉上的应力峰值在各种工况中均明显高于双侧TLIF,后伸工况时应力峰值达到463.39 MPa。结论 单侧TLIF可作为腰椎退变性疾病的一种固定方法,但应力峰值均明显高于双侧TLIF模型,故系统稳定性差于双侧TLIF模型,提示患者在康复过程中应减少后伸运动,以免发生手术失效或螺钉断裂。     

Does approach matter? A comparative radiographic analysis of spinopelvic parameters in single-level lumbar fusion

Background Context

Lumbar fusion is a popular and effective surgical option to provide stability and restore anatomy. Particular attention has recently been focused on sagittal alignment and radiographic spinopelvic parameters that apply to lumbar fusion as well as spinal deformity cases. Current literature has demonstrated the effectiveness of various techniques of lumbar fusion; however, comparative data of these techniques are limited.

Comparison of transforaminal lumbar interbody fusion outcomes in patients receiving rhBMP-2 versus autograft

Background Context

Recombinant human bone morphogenetic protein 2 (rhBMP-2) plays a pivotal role in complex spine surgery. Despite its limited approval, the off-label use of rhBMP-2 is prevalent, particularly in transforaminal lumbar interbody fusions (TLIFs).

The use of RhBMP-2 in single-level transforaminal lumbar interbody fusion: a clinical and radiographic analysis

The “off label” use of rhBMP-2 in the transforaminal lumbar interbody fusion (TLIF) procedure has become increasingly popular. Although several studies have demonstrated the successful use of rhBMP-2 for this indication, uncertainties remain regarding its safety and efficacy. The purpose of this study is to evaluate the clinical and radiographic outcomes of the single-level TLIF procedure using rhBMP-2. Patients who underwent a single-level TLIF between January 2004 and May 2006 with rhBMP-2 were identified. A retrospective evaluation of these patients included operative report(s), pre- and postoperative medical records, and dynamic and static lumbar radiographs. Patient-reported clinical outcome measures were obtained from a telephone questionnaire and included a modification of the Odom’s criteria, a patient satisfaction score, and back and leg pain numeric rating scale scores. Forty-eight patients met the study criteria and were available for follow-up (avg. radiographic and clinical follow-up of 19.4 and 27.4 months, respectively). Radiographic fusion was achieved in 95.8% of patients. Good to excellent results were achieved in 71% of patients. On most recent clinical follow-up, 83% of patients reported improvement in their symptoms and 84% reported satisfaction with their surgery. Twenty-nine patients (60.4%) reported that they still had some back pain, with an average back pain numeric rating score of 2.8. Twenty patients (41.7%) reported that they still had some leg pain, with an average leg pain numeric rating score was 2.4. Thirteen patients (27.1%) had one or more complications, including transient postoperative radiculitis (8/48), vertebral osteolysis (3/48), nonunion (2/48), and symptomatic ectopic bone formation (1/48). The use of rhBMP-2 in the TLIF procedure produces a high rate of fusion, symptomatic improvement and patient satisfaction. Although its use eliminates the risk of harvesting autograft, rhBMP-2 is associated with other complications that raise concern, including a high rate of postoperative radiculitis.