改良TLIF手术联合双侧椎弓根钉内固定治疗下腰椎退行性疾病

目的探讨改良经椎间孔椎间融合术（transforaminal lumbar interbody fusion,TLIF）联合双侧椎弓根螺钉内固定治疗下腰椎退行性疾病的手术方法和疗效。方法 2006年5月-2010年12月,采用改良TLIF手术联合双侧椎弓根钉内固定治疗下腰椎退变性疾病35例共37个节段,男19例,女16例;年龄29-68岁,平均53.6岁。Ⅰ-Ⅱ度退行性腰椎滑脱症8例,腰椎间盘突出症伴节段不稳6例,腰椎管狭窄症18例,椎间盘源性下腰痛3例。改良方法首先行病变节段双侧椎弓根螺钉内固定,切除患侧下关节突及上关节突内上1/3,将神经根减压、松解后按常规方法完成TLIF手术。结果所有病例均获得随访12-30个月,平均21.5个月,无断钉,无Cage移位,采用改良MaeNab标准评价随访结果显示优24例,良9例,可2例,优良率94.3%。按JOA下腰痛评分法显示术后平均改善率92%。结论改良TLIF手术联合双侧椎弓根螺钉内固定治疗下腰椎退行性疾病,具有创伤小、出血少、不破坏对侧结构、手术时间短等传统优势,并且术后即刻稳定性能较常规手术具有明显优势,术后功能恢复满意,是治疗下腰椎退行性疾病的有效方法。

Modified transforaminal lumbar interbody fusion with hibateral pedicle screw fixation for the treatment of low lumbar degenerative disease

Objective To explore the clinical application and result of modified transforaminal lumbar interbody fusion(TLIF) with hibateral pedicle screw fixation for the treatment of low lumbar degenerative diease.Method From Martch 2006 to December 2010,35 cases(37 levels) were treated with modified TLIF with hibateral pedicle screw fixation.There were 19 males and 16 females with average age of 53.6 years,ranging from 29 to 68 years.The preoperative diagnosis included lumbar degenerative spondylolisthesia(8 cases,G...