肌间隙入路单侧TLIF钉棒固定治疗腰椎间盘病变初步报告

目的探讨经骶棘肌间隙腰椎单侧TLIF治疗腰椎间盘病变的适应证、手术方法及临床疗效。方法对亳州市人民医院自2010年1月—2011年9月期间21例术前均有下腰痛症状且为单侧肢体麻木、疼痛的腰椎间盘病变行上述术式治疗的患者进行回顾性研究，统计手术用时、术中出血量及住院时间，比较手术前、后视觉模拟评分法（VAS）、欧氏失能指数（ODI）、改良Prolo评分变化是否具有统计学意义，随访分析改良Prolo评分优良率和腰椎术后半年融合率。结果术中出血（265．7±59．2）ml、手术时间（110．3±21．5）min、住院天数（11．3±3．2）d、术后VAS评分（3．5±0．9）分、ODI评分（15．1±1．6）分、改良Prolo评分（14．9±2．7）分，与术前相比较差异具有统计学意义（P〈0．05），其中总优良率90．5％，术后半年三维CT重建显示融合率达90．9％。结论肌间隙人路单侧TLIF钉棒固定术具有创伤小、出血量小、手术和住院时间短、对侧正常结构无破坏、早期下床、功能恢复好、融合率高的优点。但应严格掌握适应证，长期疗效还需进一步随访。

Primary report of transforaminal lumbar interbody fusion with unilateral pedicle screw fixation through paraspinal sacrospinalis-splitting approach in treatment of degeneration of lumbar intervertebral disc

Objective To investigate surgery indication, methods and therapeutic efficacy of transforaminal lumbar inter- body fusion（TLIF） with unilateral pedicle screw fixation through paraspinal sacrospinalis-splitting approach in the treat- ment of lumbar disc diseases. Methods Total 21 cases of lumbar disc diseases with lower back pain, and unilateral numbness and pain,in our hospital from January 2010 to September 2011 were enrolled in this study. All patients under- went TLIF with unilateral pedicle screw fixation through paraspinal sacrospinalis-splitting approach. The duration of opera- tions, peroperative bleeding and length of staying in hospital were recorded. The difference of visual analog scale（ VAS）, Oswestry disability index（ ODI）, modified Prolo score before and after operation were compared. Six months follow up after the surgery was conducted to evaluate the modified Prolo score good rate and the fusion rate. Results The peroperative bleeding, duration of operations, length of hospital staying was （265.7 ± 59.2） ml, （ 110.3 ± 21.5 ） min, （ 11.3 ± 3.2 ） d, respectively. Postoperative VAS, ODI, improved Prolo score was （ 3.5± 0.9 ） points, （ 15.1 ± 1.6） points, （ 14.9 ± 2.7 ） points, respectively, the difference were significant as compared to the preoperative levels（ P 〈 0.05 ）. The total excellent rate, the fusion rate at six months after surgery by 3D CT was 90.5 % and 90.9%. Conclusion The transforaminal lum- bar interbody fusion with unilateral pedicle screw fixation through paraspinal sacrospinalis-splitting approach in the treat- ment of lumbar disc diseases was effective, with advantages of less damage, less bleeding, shorter hospitalization time and higher fusion rate. It does not destroy the contralateral normal structure, so the patients have better functional recovery and ambulate earlier. But it has strictly surgery adaptation, and the long-term efficacy also needs further follow-up.