单侧置钉经椎间孔椎体融合术结合经椎板的关节突螺钉治疗退行性腰椎疾病

目的：探讨单侧置钉经椎间孔的椎体融合（transforaminal lumbar interbody fusion,TLIF）术结合经椎板关节突螺钉治疗退行性腰椎疾病的手术方法及疗效。方法：2009年3月—2009年11月,23例退行性腰椎疾病（包括腰椎退行性滑脱合并腰椎不稳定的腰椎管狭窄）患者,采用单侧置钉TLIF术结合经椎板的关节突螺钉治疗。术后随访6~12个月（平均8个月）。评价患者术后下肢及腰背部疼痛视觉模拟评分（VAS评分）]、影像学表现、以及围手术期患者并发症。结果：所有患者围手术期中均未发生血管、神经损伤等严重并发症,1例出现经椎板关节突螺钉置钉位置不佳引起神经根刺激症状,行二期手术取钉后症状缓解。所有患者术后下肢及腰背部疼痛的VSA评分明显优于术前。影像学随访未见内固定失败及矫形丢失现象。结论：采用单侧置钉TLIF术,结合经椎板关节突螺钉,可以有效地治疗退行性腰椎疾病。手术创伤小,疗效肯定。

Unilateral Instrumentation TLIF together with the Tans-Lamina Facet Joint Screw in the Treatment of the Degenerative Lumbar Disease

Objective：To study a new surgery known as unilateral instrumentation transforaminal lumbar interbody fusion（TLIF）,together with the trans-lamina facet joint screw for degenerative lumbar disease.Methods：We performed unilateral instrumentation TLIF together with the trans-lamina facet joint screw for 23 patient diagnosed as the degenerative lumbar disease.At average 8 months（6-12months） after treatment,clinical outcomes were observed with the visual analog score for both leg pain and back pain,and the radiological follow-up together with the complications in the preoperative period were also assessed.Results：There were no severe complications like the neurologic and vascular injury during the preoperative period.Only one patient suffered a radicular irritation for a mal-positioned trans-lamina facet joint screw,while relieved after the screw taken out by reoperation.All patients exhibited statistically and clinically significant improvements in the VAS scores in the follow-up and there were no radiographic signs of internal fixation failure.Conclutions： Unilateral instrumentation TLIF together with the trans-lamina facet joint screw is proved to be effective and safe in the treatment of the patients suffered from the degenerative lumbar disease.