一侧开颅清除双侧额叶挫裂伤伴出血

目的探讨一侧开颅切开额前部大脑镰清除双侧额叶挫裂伤的手术治疗可行性。方法对8例经一侧开颅清除双侧额叶挫裂伤的病例进行回顾性分析。结果术后CT复查示所有病例血肿清除满意,出院GOS评分7例为良好,1例并肺部感染自动出院。结论一侧开颅清除双侧额叶挫裂伤具有创伤小、手术时间短、失血少、患者预后好的优点,对部分病例适用。     

单额开颅治疗双额叶挫裂伤伴血肿

目的总结单额开颅治疗双额叶挫裂伤的经验。方法回顾性分析21例双额叶挫裂伤患者的临床资料,均采用单额开颅治疗。入院时GCS评分:9～11分13例,6～8分6例,3～5分2例。结果术后第1 d所有病例均行头颅CT复查,无一例出现迟发性颅内血肿或残余血肿。对侧挫裂伤及血肿基本清除(>75%)15例,部分清除(50%～75%)6例。术后6个月按GOS分级标准,恢复良好13例,中残4例,重残3例,死亡1例。结论采用单额开颅能有效清除双额叶挫裂伤及血肿,并具有缩短手术时间、减轻手术创伤等优点,具有较好的临床实用价值。     

Intracranial pressure monitoring for special patterns of frontal lobe contusions

Objective： To study the effect and indications ofintracranial pressure （ICP） monitoring for frontal lobe contusion patients. Methods： During January 2005-December 2008, 34 cases of frontal lobe contusion received ICP monitoring in our department （monitoring group）. Different treatment protocols were adopted according to the results of ICP. Mean-while 46 cases of same type of head-injured patients who did not undergo ICP monitoring served as control group. Results： We found that ICP elevated dramatically within 24 hours after head injury if the contusions were located in frontal longitudinal dehiscence, bilateral undersurface of frontal lobe or dispersed in bilateral lobe. After half a year follow-up and on the basis of Glasgow Coma Scale assessment, the monitoring group showed better outcome than the control group with good recovery in 24 cases （70.6%）, moderate disability in 7 cases （20.6%）, severe disability in 2 （5.88%） and death in 1 （2.94%）. The outcome of control group displayed good condition in 25 cases （54.3%）, moderate disabilities in 8 （17.4%）, severe disability in 7 （15.2%）, and death in 6 （13.0%）. Conclusions： Frontal lobe contusions are vulnerable and complex head injuries, especially when the contusions are located in frontal longitudinal dehiscence, bilateral undersurface of frontal lobe or diffused in bilateral lobes. These patients should undergo ICP monitoring regardless of their consciousness status. IflCP elevates over 25 mm Hg, the craniotomy is mandatory and will markedly reduce the mortality and disability of these patients.     

两种不同方法置入Dynesys内固定的早期临床对比研究

目的比较单侧剥离半椎板切除潜行对侧扩大减压联合对侧经多裂肌间隙行Dynesys内固定与双侧剥离全椎板切除Dynesys内固定治疗退行性腰椎椎管狭窄症的早期临床效果和安全性。方法 2010年2月～2011年3月27例退行性腰椎椎狭窄患者（43个节段）行Dynesys内固定手术。15例（24个节段）行症状重侧单侧剥离半椎板切除,潜行对侧扩大减压,对侧经多裂肌间隙安装Dynesys内固定;12例（19个节段）行双侧暴露全椎板切除减压安装Dynesys内固定。通过对患者术前术后疼痛视觉模拟量表（visual analog scale,VAS）评分和腰背、下肢Oswestry功能障碍指数（Oswestry disability index,ODI）,摄正侧位和动力位X线片,记录手术切口,术中术后出血量比较2种方法的临床效果和安全性。结果 27例患者得到8～20个月的随访。2组患者对比研究显示单侧剥离组的手术切口、肌肉创伤、术中出血量、术后引流量及术后初次腰痛评分改善程度优于双侧暴露安装组。影像学资料显示2组患者椎间隙前高、后高及椎间孔高度、面积均较术前明显增加。2组患者椎间隙前高、后高和椎间孔高度、面积改变量及术后节段活动度改变量差别不大。结论单侧剥离半椎板切除潜行对侧扩大减压联合对侧经多裂肌间隙行Dynesys内固定同样可以达到足够的减压效果;与双侧剥离全椎板切除减压Dynesys内固定相比,具有创伤小,术中、术后出血少,术后初次腰部疼痛评分优于后者等优点。     

高龄膝骨关节炎患者人工单髁关节置换疗效分析

目的:探讨75岁以上膝骨性关节炎患者行人工单髁关节置换术后临床疗效。方法：自2010年4月至2015年5月应用Oxford第3代人工单髁关节治疗膝内侧间室骨性关节炎患者42例,根据手术单双侧置换情况将患者分为双侧同期置换组和单侧置换组：同期置换组11例,男3例,女8例,年龄（79.18±3.06）岁;单侧置换组31例,男13例,女18例,年龄（78.16±3.48）岁。观察比较患者患膝假体生存现状、术前后血细胞比容变化、术中及术后的失血总量,比较患者术前后膝关节HSS（Hospital for Special Surgery knee-rating）评分。结果：两组术后围手术期并发症比较差异有统计学意义（P<0.05）。42例患者获得随访,时间（5.7±2.3）年。1例既往高血压合病史患者术后第4个月发生脑血栓,1例患者在术后第4个月发生衬垫脱位,2例患者于术后3年因其他内科疾病死亡（1例心肌梗塞,1例肺癌）。双侧同期置换组术后失血总量高于单侧置换组（P<0.05）;4例行双侧同期置换患者术后分别输血2 U。两组术后9个月HSS评分除稳定性评分其他各项评分和总分均高于术前（P<0.05）。结论：内侧单间室退变的75岁以上老年骨性关节炎患者选择人工单髁关节置换术是可行的手术治疗方法。对于双膝病变75岁以上老年患者,双侧同期人工单髁关节置换术同单侧单髁关节置换手术相比,创伤大,会增加围手术期并发症发生率,影响术后快速康复,增加失血量。虽然远期疗效同单侧单髁关节置换手术相当,但为保证手术安全性,仍建议分期手术。     

管状通道下单侧入路双侧减压微创经椎间孔入路腰椎椎间融合术治疗单节段腰椎退行性疾病

目的 探讨管状通道下单侧入路双侧减压微创经椎间孔入路腰椎椎间融合术(MIS-TLIF)治疗单节段腰椎退行性疾病的临床疗效.方法 2013年11月—2016年2月,同济大学附属同济医院采用管状通道下单侧入路双侧减压MIS-TLIF治疗28例单节段腰椎退行性疾病患者.记录手术时间、术中出血量、术后引流量;测量手术前后及末次...     

内窥镜下单神经孔入路腰椎减压、植骨融合内固定术42例近期临床结果

目的 探讨内窥镜（METRx）下经X-Tube单侧神经孔入路行椎间盘摘除、椎间植骨融合的疗效。方法 对2004年6月至2006年3月完成的42例内窥镜（METRx）下经X-Tube单侧神经孔入路行椎间盘摘除、椎间植骨融合的近期疗效进行总结分析。42例患者中,男17例,女25例,平均年龄51．6岁。均为腰椎间盘突出伴腰椎不稳和腰椎弓根峡部嵌裂伴滑脱的患者。结果 平均手术时间240min;平均出血量140ml;平均手术切口长度3cm;术后平均住院时间12．5d;按照Nakai分级,优23例（62．2％）,良11例（29．2％）,可3例（8．6％）。椎间植骨融合率91．9％。5例患者（11．9％）发生并发症。结论 内窥镜（METRx）下经X—Tube单侧神经孔入路行椎间盘摘除术具有手术切口小、腰骶肌肉剥离轻、出血少、术后手术伤口疼痛较轻等优点,是临床上可供选择的一种微创新术式。     

The Effect of Bilateral Globus Pallidus Internus Deep Brain Stimulation plus Ventralis Oralis Thalamotomy on Patients with Cerebral Palsy

Objective: We compared bilateral globus pallidus internus (GPi) deep brain stimulation (DBS) with bilateral GPi DBS plus ventralis oralis (Vo) thalamotomy to analyze the effect of the combined Vo thalamotomy. Methods: Between March 2003 and December 2008, 10 patients underwent DBS and/or Vo thalamotomy for treatment of cerebral palsy in our institute of neurosurgery and rehabilitation medicine. Four patients received bilateral posteroventral GPi DBS as group I and 6 patients received GPi DBS plus unilateral thalamotomy as group II. Results: The movement and disability scores of group I improved by 32 and 14.3%, respectively, at the last follow-up compared with baseline. The movement and disability scores of group II improved by 31.5 and 0.18%. The BFMDRS-movement subscores of group II demonstrated statistically significant improvement in the contralateral arm compared to group I (p = 0.042). Body pain, vitality and mental health seemed to improve in group II, in terms of health-related quality of life. Conclusions: Contrary to our expectations, we were unable to demonstrate clear improvements in overall BFMDRS scores between group I and group II. However, movements of the contralateral upper extremities improved and health-related quality of life in group II showed satisfactory results.     

Analysis of complications of radiofrequency pallidotomy

OBJECTIVE: To systematically report the complications of pallidotomy and to tentatively determine the incidences of complications of pallidotomy, possible influencing factors, and the acceptability of symptomatic hemorrhage rates for microelectrode-guided pallidotomy. METHODS: Clinical events were analyzed for 1116 patients with Parkinson's disease who underwent microelectrode-guided pallidotomies at our center. Complications included visual field deficits, weakness, fatigue, hypersomnia, drooling, dysphagia, speech disorders, hiccups, hemorrhage, seizures, apraxia, coma, infection, mental confusion, and impaired memory. Complication rates for bilateral pallidotomy and double-lesion groups were compared with those for unilateral pallidotomy and single-lesion groups, respectively. RESULTS: Among the total of 1116 patients, the incidences of visual field deficits, weakness, fatigue, hypersomnia, drooling, dysphagia, and speech disorders were 0.4, 4.2, 19.9, 12.4, 7.0, 3.7, and 11.9%, respectively. Symptomatic hemorrhage was observed for 17 patients, apraxia for 3 patients, coma for 2 patients, mental confusion for 24 patients, and impaired memory for 18 of the 1116 patients. The incidences of fatigue, speech disorders, drooling, dysphagia, and hypersomnia were 18.1, 10.3, 5.2, 2.4, and 11.6%, respectively, in the unilateral pallidotomy group and 34.9, 25.5, 22.6, 14.2, and 17.0%, respectively, in the staged pallidotomy group. Of the three patients who underwent simultaneous bilateral pallidotomies (all <50 yr of age), all developed severe fatigue and two exhibited drooling and dysphagia. The incidences of weakness, fatigue, speech disorders, drooling, dysphagia, and hypersomnia were 8.7, 30.4, 18.8, 7.2, 2.9, and 20.3%, respectively, in the double-lesion group and 3.2, 17.2, 9.7, 5.0, 2.3, and 11.5%, respectively, in the single-lesion group. CONCLUSION: Staged bilateral pallidotomy should be carefully evaluated before decision-making, whereas simultaneous bilateral pallidotomy is undesirable. Our study suggests that the size of the final lesion should be limited, to minimize the risks of complications. The incidence of symptomatic hemorrhage in microelectrode-guided pallidotomy is low and acceptable, because of the benefits of microelectrode-guided pallidotomy.     

双侧棘突旁小切口在后路单节段腰椎椎体间融合术中的应用

 目的 比较经双侧棘突旁小切口和传统开放切口行后路单节段腰椎椎体间融合术的效果, 以评估小切口术式的应用价值。方法 2006年 12月至 2008年 6月, 对 70例下腰椎病变患者行后路单节段腰椎椎体间融合术, 将患者随机分为双侧棘突旁小切口组(36例)和传统切口组(34例)。小切口组: 男 20例, 女 16例;年龄 35耀64岁, 平均 52.0岁。传统切口组: 男 16例, 女 18例;年龄 38耀62岁, 平均 53.2岁。分别对两组患者手术基本情况、并发症发生率、肌酸激酶水平、多裂肌的横截面积、术后腰背痛视觉模拟评分(visual analogue scale, VAS)、Oswestry功能障碍指数、椎间融合率进行对比分析。结果 70例患者均获得随访, 时间 12~24个月, 平均 16个月。两组病例手术时间、术中 X线投照次数、并发症发生率、椎间融合率比较差异无统计学意义(P跃0.05), 但小切口组在术中出血量、术后引流量、术后第 1天及第 3天肌酸激酶水平、术后多裂肌横截面积、术后腰背痛 VAS、住: 时间、术后 Oswestry功能障碍指数等方面与传统切口组比较差异均有统计学意义(P< 0.05)。结论经双侧棘突旁小切口或传统切口行后路单节段腰椎间融合术的疗效均满意, 但双侧棘突旁小切口术式具有手术创伤小、住: 时间短、术后恢复快、多裂肌萎缩少等优点。     

The effect of bilaterality,pathological features and surgical outcome in nonhereditary renal cell carcinoma

PURPOSE: We evaluated the differences in cancer specific, distant metastasis-free and local recurrence-free survival in patients with sporadic subtype concordant bilateral synchronous renal cell carcinoma and those with unilateral renal cell carcinoma, controlling for the covariates of subtype, stage, tumor size, grade and necrosis. We also analyzed early surgical complications and long-term renal function in patients who underwent staged surgery and those who underwent a single operation for bilateral synchronous renal cell carcinoma. MATERIALS AND METHODS: We retrospectively evaluated 44 patients with sporadic subtype concordant bilateral synchronous renal cell carcinoma treated at our institution between 1970 and 1998. There were 32 patients with bilateral synchronous clear cell renal cell carcinoma and 12 with bilateral synchronous papillary renal cell carcinoma. These patients were compared with 1,714 with sporadic unilateral clear cell renal cell carcinoma and 322 with sporadic unilateral papillary renal cell carcinoma treated with partial or radical nephrectomy during that period. Outcomes were estimated using the Kaplan-Meier method and Cox proportional hazard models were used to test associations with outcome. RESULTS: Clinicopathological features were similar for patients with bilateral synchronous and unilateral renal cell carcinoma except for the incidence of multifocality, which was 28% and 33% for bilateral synchronous clear cell and papillary renal cell carcinoma compared with 2% and 7% for unilateral clear cell and papillary renal cell carcinoma, respectively. Cancer specific survival and distant metastasis-free survival in patients with bilateral synchronous disease was similar to that in those with unilateral disease when controlling for subtype, stage, tumor size, grade and tumor necrosis. However, patients with bilateral synchronous clear cell renal cell carcinoma were more likely to experience local recurrence even after controlling for these covariates. The majority of patients (84%) with bilateral synchronous disease underwent bilateral surgery at a single operation. The incidence of early surgical complications was low, in that only 2 patients had urinary extravasation, 3 had acute renal failure and 1 was ultimately rendered anephric and required hemodialysis. CONCLUSIONS: The incidence of multifocality was greater in patients with bilateral synchronous renal cell carcinoma than in those with unilateral renal cell carcinoma. There were no statistically significant differences in cancer specific and distant metastasis-free survival in patients with bilateral synchronous renal cell carcinoma and unilateral renal cell carcinoma of the same histological subtype. These results suggest that subtype concordant bilateral renal cell carcinoma is a result of multiple de novo primary events rather than primary renal cell carcinoma with contralateral renal metastasis. A surgical approach is appropriate for bilateral synchronous renal cell carcinoma and most cases can be approached at a single surgical procedure with acceptable morbidity.     

椎弓根固定结合经椎间孔椎间融合治疗复发性腰椎间盘突出症伴腰椎不稳

目的：探讨经肌间隙入路椎弓根固定结合经椎间孔椎间融合（transforaminal lumbar interbody fusion,TLIF）治疗复发性腰椎间盘突出症伴腰椎不稳的临床疗效。方法：2008年3月至2010年5月收治35例复发性腰椎间盘突出症,其中15例行经肌间隙入路单边椎弓根固定结合TLIF术式（单边固定组）,20例行后正中入路双边椎弓根固定结合后路椎间植骨融合（posterior lumbar interbody fusion,PLIF）术式（双边固定组）.观察手术时间、术中出血量,并比较手术前后两组患者JOA评分、腰痛及腿痛VAS评分及融合情况。结果：所有患者获得随访,时间6～30个月,平均16.8个月。两组患者腰腿痛等临床症状较术前明显缓解,X线片显示植骨融合良好（双边固定组中1例未融合）,无融合器移位、下沉及内固定器械松动或断裂。两组患者手术时间、术中出血量比较差异有统计学意义（P<0.05）.术后JOA评分均较术前降低（P<0.05）.术后1周,两组患者腰痛VAS评分比较差异有统计学意义（P<0.05）,腿痛VAS评分比较差异无统计学意义（P>0.05）;末次随访,腰痛及腿痛VAS评分两组比较差异无统计学意义（P>0.05）.结论：两种术式在治疗复发性腰椎间盘突出症伴腰椎不稳均可达到满意的疗效,经肌间隙入路单边椎弓根固定结合TLIF术式切口较小,手术时间较短,术中出血量较少,术后腰痛缓解较快。     

对冲性颅脑损伤双侧血肿的手术策略

【摘要】〓目的〓探讨对冲性颅脑损伤所导致的颅内双侧血肿的手术策略,以提高此类患者的预后。方法〓回顾分析我院颅脑创伤中心2011年10月至2014年10月由同一术者手术治疗的97例对冲性颅脑损伤患者的病例资料,根据术前头CT所示,将患者分为三型,Ⅰ型:着力侧硬膜外血肿为主(20例),Ⅱ型:着力侧硬膜外血肿量与对冲侧血肿量(硬膜下血肿或者脑挫裂伤伴实质内血肿)相当(29例),Ⅲ型:对冲侧血肿(硬膜下血肿或者脑挫裂伤伴实质内血肿)为主(48例)。对上述三型患者采取针对性的手术治疗。结果〓Ⅰ型患者主要先行着力侧的硬膜外血肿手术处理,对冲侧根据术前(达到手术指征同期手术)及术后(复查CT,血肿增多达到手术指征即手术,未增多则行颅压监护)情况决定是否手术;Ⅱ型患者术前双侧血肿未达手术指征根据GCS评分及瞳孔决定是否手术,达到手术指征则行同期双侧血肿清除;Ⅲ型患者先行着力侧钻孔引流,再行对冲侧血肿清除,术中使用超声检查着力侧血肿决定进一步治疗。根据GOS评分判断患者预后,其中预后良好45例,轻度残疾22例,重度残疾11例,植物生存11例,死亡8例。结论〓对冲性颅脑损伤双侧血肿患者根据术前头CT血肿分型采取针对性的手术策略,可以取得较好的预后。     

单切口入路行双侧睾丸手术

目的探讨单切口入路行双侧阴囊手术的可行性. 方法回顾性分析27例采用单侧或正中阴囊皮肤直切口同期行双侧阴囊手术的临床资料. 结果 27例患者中,行单侧阴囊皮肤直切口15例,其中前列腺癌8例,双侧附睾结节2例,一侧附睾结节伴另一侧睾丸鞘膜积液2例,双侧睾丸鞘膜积液3例;行阴囊皮肤正中直切口12例,其中前列腺癌9例,双侧附睾结节2例,一侧附睾结节伴另一侧睾丸鞘膜积液1例.所有患者术后均未出现阴囊或下腹部血肿,伤口甲级愈合.结论与传统的双侧阴囊切口相比,阴囊单切口减少了皮肤切口,缩短了手术时间,减少了患者痛苦,疗效满意,值得推荐.     

Bilateral middle cerebral artery aneurysms: a comparative study of unilateral and bilateral approaches

The best surgical method for the treatment of patients with bilateral middle cerebral artery (bMCA) aneurysms has not been fully determined yet. The main purpose of this study is to compare the surgical results of unilateral and bilateral approaches to bMCA aneurysms including mean operation time, mean hospital stay, and mean cost, in the experience of the same neurosurgical team. Between January 2001 and June 2010, 22 patients with bMCA aneurysms were surgically treated in our institution. In 12 cases (54.5?%), ipsilateral and contralateral MCA aneurysms were successfully clipped via unilateral approach. In the remaining 10 cases, bilateral approach was necessary because of some technical difficulties. Although the surgical results were almost the same, mean operation time and mean hospital stay were, respectively, 46 and 37?% shorter and mean cost per person was 23?% lower for the patients in the unilateral group. In addition, the severity of brain edema, total length of the contralateral (A1+M1) segment, and the configuration of contralateral aneurysm were found to be the determinant parameters affecting the feasibility of the unilateral approach. To our knowledge, this is the first study in the literature that compares the clinical outcomes of unilateral and bilateral approaches to bMCA aneurysms. The results of surgery for both approaches are almost the same. However, the unilateral approach has certain advantages compared to the bilateral approach. Therefore, the unilateral approach may be a good alternative in surgical management of patients with bMCA aneurysms in selected cases and the abovementioned parameters can help the neurosurgeon in patient selection.     

单、双侧顺行脑灌注在主动脉病变深低温停循环手术中的效果比较

目的 探讨单、双侧顺行脑灌注在主动脉病变深低温停循环手术中的脑保护效果.方法 60例主动脉病变行深低温停循环手术病人随机分成顺行脑灌注单侧组和舣侧组,每组30例.于体外循环开始时(T_1)、停循环时(T_2)、脑灌注25 min时(T_3)、脑灌注结束时(T_4)、体外循环结束时(T_5)以及术后1 h(T_6)、6 h(T_7)、24 h(T_8)时抽取右侧颈静脉球鄙血液,采用双抗体夹心ELISA法测定血清中S-100β蛋白和神经元特异性烯醇化酶(NSE)浓度;比较两组病人的中枢神经系统并发症的发生率及病死率.结果 T_1～T_3时间点曲组间S-100β和NSE浓度差异无统计学意义,T_4～T_8时间点差异均有统计学意义.单侧组中楸神经功能障碍发生率明显较舣侧组高(33.33%对10.00%,P=0.028),两组病死率差异无统计学意义(3.33%对6.66%,P=1.000).结论 在主动脉病变深低温停循环手术中,停循环25 min内单、舣侧顺行脑灌注效果相当,但超过25 min,双侧顺行腑灌注脑保护效果更佳.     

DELTA内镜下单侧入路双侧减压治疗腰椎椎管狭窄症的疗效分析

目的 探讨DELTA内镜下单侧入路双侧减压治疗单节段腰椎管狭窄症的临床疗效.方法 选取广东省中医院骨科自2018年1月～2019年6月手术治疗的60例单节段腰椎管狭窄症患者,根据手术方式不同分为DELTA组和MIS-TLIF组,DELTA组采用DELTA内镜下单侧椎板间入路双侧减压术治疗,MIS-TLIF组采用微创管道...     

微创经椎间孔入路腰椎椎间融合术中应用单/双切口完成双侧内固定治疗腰椎退行性疾病

目的探讨并分析微创经椎间孔入路腰椎椎间融合术(MIS-TLIF)中应用单/双切口完成双侧内固定治疗腰椎退行性疾病的效果。方法回顾性分析2013年2月—2016年2月本院MIS-TLIF治疗的86例腰椎退行性疾病患者临床资料,其中采用单侧切口完成双侧内固定组40例(试验组),采用双侧切口完成双侧内固定组46例(对照组)。采用疼痛视觉模拟量表(VAS)评分和Oswestry功能障碍指数(ODI)在术前,术后1 d,术后3、6、12个月评估2组患者疼痛程度及腰椎功能;记录2组患者切口长度、术中出血量、手术时间、卧床时间、住院时间、并发症发生情况及融合情况等信息。结果所有手术均顺利完成。试验组平均切口长度、手术时间、术中出血量、卧床时间、住院时间均优于对照组,差异均有统计学意义(P 0.05)。2组患者术前腰椎功能优良率和VAS评分比较差异无统计学意义(P0.05);试验组术后3、6个月腰椎功能优良率明显高于对照组,差异有统计学意义(P 0.05),而术后1 d、12个月组间差异无统计学意义(P 0.05);试验组术后1 d、3个月VAS评分明显低于对照组,差异有统计学意义(P 0.05),而术后6、12个月组间差异无统计学意义(P 0.05)。结论 2种方式完成双侧内固定在MIS-TLIF中应用效果相当,但单侧切口较双侧内固定具有创口更小,术中出血量更少,愈合时间、卧床时间及住院时间更短,且可减轻术后疼痛,加速腰椎功能恢复等优点。     

Large bone-flap decompressive craniotomy for treatment of serious craniocerebral injury associated with cerebral infarction

Objective:To elucidate the therapeutic effect of subtemporal decompressive craniotomy with large flap resection on serious craniocerebral injury associated with cerebral infarction.Methods:Forty-eight ...     

单侧椎弓根螺钉固定椎体间融合治疗腰椎退行性疾病

目的 探讨单侧椎弓根螺钉固定经椎间孔椎体间融合(transforaminal lumbar interbody fusion,TLIF)联合后外侧融合(posterolateral fusion,PLF)技术治疗腰椎退行性疾病的可行性及有效性.方法 分析2006年12月至2008年8月收治的因患腰椎退行性疾病行腰椎后路融合术并获得随访的患者78例.采用单侧椎弓根螺钉固定TLIF联合PLF技术治疗48例(单侧组),男25例,女23例;年龄31～64岁,平均47.6岁.采用双侧椎弓根螺钉固定TLIF联合PLF技术治疗30例(双侧组),男21例,女9例;年龄26～66岁,平均50.5岁.使用Oswestry功能障碍指数,疼痛视觉模拟评分(visual analogue score,VAS)评估两组患者术后疗效,并比较两组患者手术时间、出血量、融合率和椎间隙塌陷率等指标.结果 两组患者的Oswestry功能障碍指数、腰痛VAS评分、腿痛VAS评分在术前与术后3个月以及术后3个月与术后1年之间比较差异均有统计学意义,在术前与术后1年的评分改善方面差值比较无统计学意义.两组患者手术时间、出血量及住院费用比较差异均有统计学意义,单侧组少于双侧组.两组患者术后住院时间比较差异无统计学意义.单、双侧组融合率分别为91.7%(44/48)和93.3%(28/30).结论 椎间植骨联合单侧椎弓根螺钉固定能提供较好的脊柱即刻稳定性.单侧椎弓根固定TLIF联合PLF技术作为一种治疗腰椎退行性疾病的方法,疗效满意.