微创单侧TLIF辅助单边钉棒固定治疗腰椎间盘病变的初步报告

目的探讨采用微创经腰椎间孔椎体间融合术（TLIF）辅助单边钉捧固定治疗腰椎间盘病变的适应证、手术方法及初步疗效。方法自2006年1月至2008年6月，15例腰椎间盘病变患者进行微创TLIF治疗。其中，男性7例，女性8例：年龄48～64岁，平均年龄54．7岁．病程1．5～3．0年，平均2年。其中L3-43例L4-5，8例，L5-S17例：单节段病变12例．双节段病变3例．术前视觉模拟评分法（VAS）评分为（7．6±1．0）分，欧氏失能指数（ODI）评分为（42．4±2．7）分．Prolo功能评分为（10．5±1．6）分，、所有患者均有下腰痛．仅有单侧下肢痛、麻木。结果手术时间120～240min，统计数据（182．3±35．5）min。术中出血150．420mL．统计数据（280．7±81．2）mL。住院天数7～35d．统计数据（17．7±6．2）d。所有病例随访时间8～21个月，平均随访时间15．2个月。术后VAS评分（3．0±0．8）分，ODI评分（16．4±2．9）分．改良Prolo评分（17．0±0．9）分，与术前比较差异有统计学意义（P〈0．05），其中优9例，良4例，可2例，总优良率86．7％。该组15例18个融合节段，术后6个月三维CT重建，有15个节段融合，融合率833％。结论微创TLIF辅助单边钉棒系统同定具有软组织损伤小、出血量少、不破坏对侧的正常结构、住院时间短、功能恢复好、并发症发生率低的优点。但应严格掌握适应证．长期结果还需进一步随访，

Preliminary report on minimally invasive unilateral transforaminal lumbar interbody fusion with unilateral pedicle screw fixation in lumbar spinal degenerative disease

Objective To explore the clinical application, operation approach and preliminary result of minimally invasive unilateral transforaminal lumbar interbody fusion（TLIF） with unilateral pedicle screw（UPS） fixation in the treatment of lumbar spinal degenerative disease. Methods From January 2006 to June 2008, 15 cases of lumbar spinal degenerative disease were treated with minimally invasive TLIF with UPS, male 6 and female9, mean age 54.7 years（range, 48 - 64 years）. The mean course of their diseases was 2 years（range, 1.5 - 3.0 years）. There were 12 cases of single-level degenerative intervertebral disc diseases and 3 cases with two-levels, including 3 cases of L3-4, 8 cases of L4-5, and 7 cases of L5 - S1. Before operation, the score of visual analog scale（VAS） was 7.6 ±1.0, the score of Oswestry disability index（ODI） was 42.4±2.7 and the score of modified Prolo was 10.5 ±1.6, respectively. All patients had suffered lower back pain, or only combined with unilateral lower limb pain and numbness. Results The mean operative time was （182.3 ±35.5） minutes（range, 120 - 240 minutes）, mean intraoperative blood loss was （280.7 ±81.2） mL （range, 150 - 420 mL）, and mean hospitalization time was （17.7±6.2） days（range, 7 - 35 days）. All eases were followed up from 8 to 21 months （mean 15.2 months）. After operation, the score of VAS was 3.0 ±0.8, the score of ODI was 16.4 ±2.9 and the score of modified Prolo was 17.0 ±0.9, respectively. The difference between pre and post operation were statiscally significant（P 〈 0.05）. The clinical results were excellent in 9 cases, good in 4 and fair in 2 with choiceness rate 86.7 %. Of 15 levels got interbody bony fusion from total 18 levels, 15 cases confirmed by three-dimensional reconstructive CT in 6 months after operation, the fusion rate was 83.3 %. Conclusion It is demonstrated that minimally invasive TLIF with UPS has the advantages of small trauma and bleeding, no destroying contralateral structure, short operation time, quick recovery and low complication rate. But the operation indications must be strictly defined and long-term studies are required.