微创TLIF手术治疗腰椎间盘突出症

目的 探讨微创经椎间孔腰椎椎体间融合术(TLIF)治疗腰椎间盘突出症的疗效.方法 15例腰椎间盘突出症采用微创TLIF手术治疗,所有病例均为单节段椎间盘突出,其中伴有节段不稳定6例,超外侧间盘突出9例;腰3/4节段2例,腰4/5节段10例,腰5骶1节段3例.观察手术时间、出血量、创面大小、术后下地活动时间、术中的X线透视时间及并发症等.采用VAS评分评估手术前后疼痛缓解情况.结果 15例微创TLIF的手术时间平均3.4h,出血量100ml,切口长3cm,无伤口引流管,术后1d下地活动,术中X线透视时间27-38s.随访6-30个月,患者术后症状缓解,VAS评分从术前8.3分恢复到术后第3天4.7分、1周时3.8分、1个月时2.6分,与术前相比有显著性差异(P＜0.05).1例患者出现椎弓根钉进入椎管内,出现下肢无力,再次手术重置椎弓根钉同定,术后1个月症状完全消失.结论 微创TLIF手术治疗腰椎间盘突出症手术创伤小,脊柱结构破坏少,可早期下床活动,术后效果良好.

Minimally invasive transforaminal lumbar interbody fusion in the treatment of lumbar intervertebral disc herniation

Objective To investigate the efficacy of minimally invasive transforaminal lumbar interbody fusion （TLIF） in the treatment of lumbar intervertebral disc herniation. Methods A total of 15 cases with single-segmented lumbar intervertebral disc herniation （6 with instability, 9 with extreme lateral disc herniation） underwent the minimally invasive TLIF. With respect to the location, 2 cases were in L3/4, 10 cases in L4/5, and 3 cases in L5/S1. Clinical data were recorded in terms of surgery duration, blood loss, trauma size, postoperative activity time off bed, intra- operative x-ray exposure time, and complications. Pain was assessed by the visual analog scale （VAS） preoperatively and postoperatively to evaluate the degree of pain relief. Results The mean surgery duration was 3.4 hours, mean blood loss 100 ml, and mean incision length 3cm. There was no drainage tube. Patients started walking off bed 1 day post- operatively. The intra-operative x-ray exposure time varied from 27 to 38 seconds. Patients were followed up for 6 to 30 months, and their symptoms were relieved postoperatively. The postoperative VAS scores （4.7 in 3 days, 3.8 in 1 week, 2.6 in I month） showed significant difference （P〈0.05） in comparison with the preoperative one （8.3）. 1 case reported lower extremity weakness in that the pedicle screw entered the vertebral canal, and was re-operated to replace the pedicle screw for fixation. The symptoms eliminated in 1 month after the re-operation. Conclusions The minimally invasive TLIF in the treatment of lumbar intervertebral disc herniation has the advantages of smaller incision, less damage to the spinal structure, earlier action offbed, and good postoperative outcome.