单侧微创经椎间孔腰椎体间融合术采用椎弓根螺钉结合经椎板关节突螺钉混合内固定可行性研究

目的 探讨单侧切口微创经椎间孔腰椎体间融合术(MIS-TLIF)采用椎弓根螺钉结合对侧经椎板关节突螺钉混合内固定的可行性和安全性.方法 2010年1月至6月18例单节段腰椎退变性疾病患者,采用单侧切口METRxTM X-tube进行MIS-TLIF手术,同侧置入椎弓根螺钉后进行加压固定,同一切口向对侧置入经椎板关节突螺钉,进行围手术期指标观察、影像学和术后疗效评价.结果 所有患者均顺利完成手术,未出现并发症.平均手术时间(107±19)min,术中出血量(62±21)ml,术后平均下床活动时间(21±5)h.经椎板关节突螺钉平均长度(52± 2) mm.术后X线和CT显示螺钉均穿过关节突关节,术后和随访期间腰痛和腿痛视觉模拟评分与Oswestry功能障碍指数评分与术前相比均明显改善(F =42.221 ～259.833,P＜0.01).结论 单侧切口MIS-TLIF可完成椎弓根螺钉结合经椎板关节突螺钉的双侧混合内固定,具有创伤小、恢复快、缩短手术时间、节省内固定费用等优点.

A feasibility research of unilateral incision minimally invasive transforaminal lumbar interbody fusion using pedicle screws and a translaminar screw hybrid fixation

Objective To investigate the feasibility and safety of unilateral incision hybrid fixation using pedicle screws and a translaminar screw in minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF).Methods From January to June 2010,18 patients with single-level lumbar disc disease were treated with MIS-TLIF under METRxTM X-tube.After decompression and fixation using unilateral pedicle screws,a translaminar screw was inserted from the same incision to the other side.The results of perioperative parameters,radiographic images and clinical outcomes were assessed.Results All patients underwent MIS-TLIF were accomplished unilateral hybrid fixation without any neural complication.The average operative time was (107 ± 19)min,the average operative blood loss was(62 ± 21 )ml,and the average postoperative ambulation time was (21 ± 5 ) h.The average length of translaminar facets screw was (52 ± 2)mm,and the postoperative images showed all screws penetrate through facets joint.During the follow-up the visual analogue scale and Oswestry disability index scores were significant improved compared with preoperative ( F =42.221-259.833,P ＜ 0.01 ).Conclusions Bilateral hybrid fixation could be completed through unilateral incision by pedicle screws and a translaminar screw in MIS-TLIF,and the advantage including less invasion,quickly recovery,short operative time,and saving fixation cost.