改良TLIF治疗腰椎退变性疾病

目的探讨改良TLIF治疗腰椎退变性疾病的疗效。方法用改良TLIF手术治疗L3～S1退变性疾病患者24例,共融合40个节段,其中单节段8例,双节段16例。男14例,女10例;年龄56～78岁,平均64.6岁。退变性滑脱伴椎管狭窄6例,峡不连性滑脱4例,退变性腰椎管狭窄症10例,巨大椎间盘脱出合并椎间失稳4例。术中根据病情需要,采用椎管扩大减压后切除整个下关节突,切除上关节突上部的内侧半,部分开放椎间孔后壁,椎间隙自体微粒骨打压植骨,Cage斜向中线40°方向植入椎间隙,辅以椎弓根螺钉固定完成改良TLIF。结果术中无并发症发生,24例均获得随访,时间12～20个月,平均17.4个月。所有患者于术后1年随访时均达椎体间融合,无螺钉断裂和Cage移位、沉陷。10例腰椎滑脱者滑脱完全复位并维持良好。根据JOA评分法,本组术前(13.8±4.1)分,末次随访时(24.9±3.0)分,临床改善程度达优16例,良6例,可2例,平均改善率79.5%。结论改良TLIF扩大了手术适应证,贯彻了TLIF技术的设计思想和微创理念,使操作更加简单、安全,用于下腰椎退变性疾患的治疗效果满意。

Modified transforaminal lumbar interbody fusion for the treatment of lumbar degenerative disease

Objective To analyze the clinical effects of modified transforaminal lumbar interbody fusion（TLIF）for the treatment of lumbar degenerative disease.Methods 24 patients with lumbar degenerative disease（L3～S1） were treated by modified TLIF.There were 14 males and 10 females with an average age of 64.6years（56～78years）.A total of 40 levels were fused,including 8 cases of single level and 16 cases of double levels.The results of preoperative diagnosis were lumbar degenerative spondylolisthesis with stenosis（6cases）,isthmic spondylolisthesis（4cases）,degenerative lumbar stenosis（10cases）,huge herniated disc with segmental instability（4cases）.During the modified TLIF procedure,total inferior facet process and inner half summit of superior facet process of TLIF side were resected to make the posterior wall of foramen opened partly.After decompression,intervertebral tamped autobone particles transplantation,a single Cage was inserted obliquely from 40°toward the midline.Combined with pedicle screw instrumentation,TLIF was accomplished.Results All patients underwent surgery safely without severe complications occurred.The average following up time was 17.4 months（12～20 months）.At the follow-up after 1 year postoperatively,all the operated segments achieved fusion standard and no broken screw or Cage dislocation occurred.All 10 cases of spondylolisthesis were reduced thoroughly and maintained satisfactorily.There was significant difference（P0.05） in JOA score between preoperation（13.8±4.1） and postoperation（24.9±3.0）.The rate of clinical improvement was 79.5%（excellent in 16 cases,good in 6 cases,and fair in 2 cases）.Conclusion The modified TLIF expands the indication of TLIF,carries out the less invasive principles in opening operations,simplifies the manipulation and the clinical results for the treatment of lumbar degenerative disease is satisfactory.