单侧椎弓根螺钉内固定联合经椎间孔入路腰椎椎间融合术治疗腰椎退行性疾病

目的评价单侧椎弓根螺钉内固定联合经椎间孔入路腰椎椎间融合术(TLIF)治疗腰椎退行性疾病的长期临床疗效。方法回顾性分析2005年3月-2007年10月采用单侧椎弓根螺钉内固定联合TLIF治疗的38例腰椎退行性疾病患者资料,记录手术时间、术中出血量、住院时间。采用疼痛视觉模拟量表(VAS)评分评估患者术前、术后疼痛情况,以日本骨科学会(JOA)评分和Oswestry功能障碍指数(ODI)评价疗效。通过影像学资料测量不同部位椎间隙高度及手术节段椎间Cobb角,并评估术后椎间融合情况,分析相关并发症。结果38例患者均顺利完成手术,平均手术时间为120 min,平均术中出血量为200 mL,平均住院时间为12 d,手术切口均一期愈合。所有患者随访10~12年,平均11.3年,末次随访时VAS评分、JOA评分、ODI及影像学测量指标均较术前显著改善,差异均有统计学意义(P<0.05)。末次随访时椎间总融合率为94.7%(36/38)。12例(31.6%)患者相邻节段发生退行性变。未发现继发性脊柱侧凸,未见融合器移位或螺钉松动、断裂等情况。结论单侧椎弓根螺钉内固定联合TLIF治疗腰椎退行性疾病手术创伤小,疗效显著,但必须掌握手术适应证。

Unilateral pedicle screw fixation with transforaminal lumbar interbody fusion for lumbar degenerative diseases

Objective To evaluate long-term(more than 10 years) outcomes of unilateral pedicle screw fixation combined with transforaminal lumbar interbody fusion(TLIF) for the treatment of lumbar degenerative diseases. Methods From March 2005 to October 2007,38 patients with degenerative disorders of the lumbar spine were treated by unilateral pedicle screw fixation combined with TLIF. The operation time,intraoperative blood loss and hospital stay were recorded. Preoperative and postoperative pain was analyzed by the visual analog scale(VAS) score,and functional results were evaluated by Japanese Orthopedic Association(JOA) score and Oswestry disability index(ODI). The preoperative and postoperative radiologic parameters were measured,including Cobb''s angle and the disc height. Radiographic examinations were carried out to assess the total fusion rate and general complications. Results All the operations of 38 patients were successfully performed. The mean operation time was 120 min,the mean intraoperative blood loss was 200 mL,the mean hospital stay was 12 d,and all the incisions were healed primarily. The mean follow-up was 11.3 years,with a range of 10-12 years. The VAS score,JOA score,ODI and radiological indexes at the final follow-up were improved compared with the preoperative ones,all with a statistical significance(P<0.05). At the final follow-up,the total fusion rate was 94.7%(36/38). The incidence of adjacent segment degeneration was 31.6%(12/38). There were no complications such as secondary scoliosis,intervertebral height loss,cage migration,screw loosening or internal fixation failure. Conclusion Unilateral pedicle screw fixation with TLIF can be an ideal method for the treatment of lumbar degenerative diseases with little surgical trauma and better postoperative effect. The indications for operation must be strictly followed.