经椎间孔椎间融合术治疗腰椎退变性疾病的临床研究

目的分析经椎间孔椎间融合术（transforaminal lumbar interbody fusion，TLIF）手术治疗腰椎退变性疾病的临床资料与手术疗效。方法对2004年1月-2008年6月经TLIF手术治疗的26例病例进行回顾性分析。均采用TLIF方法通过一侧椎间孔抵达椎间盘间隙摘除椎间盘，处理椎间隙后置入椎间融合器。结果所有患者术后平均下床活动时间为4．5d。1例患者术后出现切口皮缘坏死，经清创缝合后愈合；1例患者出现健侧神经根牵拉伤，门诊随访4个月后恢复；其余患者均获得6～36个月随访，平均18．3个月。采用改良MaeNab标准评价随诊结果显示优良率达到92．3％。采用JOA下腰痛评分显示优良率达到92．24％。结论TLIF手术技术具有手术创伤小、恢复活动能力快、术后并发症少及疗效好等优点，是治疗腰椎退行性疾病非常有效的方法之一。

Clinical research of transforaminal lumbar interbody fusion in the treatment of degenerative disorders of lumbar spine

Objective To analyze the clinical data of patients with degenerative disorders of lumbar spine and the effect of transforaminal lumbar interbody fusion (TLIF).Methods A retrospective analysis was performed in 26 cases with degenerative disorders of lumbar spine underwent TLIF from January 2004 to June 2008. The approach involved a posterior mini median incision. Through lateral intervertebral foramen, intervertebral discs were resected and the titanium cages were replaced. The surgical process, outcomes and complications were reviewed retrospectively.Results The average period of follow-up was 18.3 months (6-36 months). The mean operation time was 145 min.The average intraoperative blood loss was 387 mL.The time of getting out of bed activities after operation was 4.5 d. The excellence and good rate of MaeNab's improved standards was 92.3%. The satisfactory results were obtained at mean 92.24% according to the criteria of JOA. One case with skin necrosis postoperatively had wound healing after excision and sutura. One case appeared nerve root traction damage of unaffected side, and recovered after 4 months postoperatively. Conclusion TLIF can restore physiological lumbar curve effectively and prevent postoperative instability by fusing of 360°, and it is one of effective surgical treatments for degenerative disorders of lumber spine.