经椎间孔入路腰椎体间融合术治疗腰椎不稳症

目的探讨经腰椎间孔入路行腰椎椎体间植骨融合术治疗腰椎不稳症的手术适应证、技术要点及应用价值。方法自2002年2月~2005年3月,对腰椎不稳56例行腰椎后正中入路,经单侧腰椎间孔行椎体间植骨融合,腰椎后方上下椎板间、棘突间、关节突间植骨,以及相应节段椎弓根钉内固定术。结果56例手术切口均一期愈合,无神经损伤、椎间隙感染和脑脊液漏等并发症。52例经6~37个月随访,平均16个月,未发生内置物断裂、松动移位和椎间隙高度丧失,骨融合率为90·38%。依据日本JOA疗效评定标准,优29例,良16例,可3例,差4例,总优良率为86·5%。结论经腰椎间孔入路椎间植骨融合术(TLIF)治疗腰椎不稳症,不但技术操作可行,而且能明显降低因侵入椎管而带来的各种可能发生的并发症,是治疗退变性腰椎不稳症的有效手术方式。

Treatment of Lumbar Instable Disorders with Transforaminal Lumbar Interbody Fusion

Objective To evaluate the surgical indications,the technique points and the clinical effect for the treatment of the lumbar instability with transforaminal lumbar interbody fusion(TLIF).Methods From February 2002 to March 2005,56 patients with lumbar instable disorders were treated with transforaminal lumbar interbody fusion,intervertebral bone grafting and pedicle screw fixtion. Results Fifty-two patients were followed up from 6 to 37 months(average 16 months).Acording to the standard of JOA:29 cases were excellent,16 good,3 improved and 4 worse.Excellent and good treatments were 86.5%.Intervertebral fusion was 90.38%.Conclusion The technique of the transforaminal lumbar interbody fusion(TLIF)is feasible for the treatment of the severe lumbar instability.It is helpful in reducing the epidural fibrosis and scar formation.The technique of the TLIF with the pedicle screw fixtion has a good clinical effect on severe lumbar instable disorders in the operation.