工作区域内移的改良经椎间孔腰椎椎体间融合术

摘要

Objective To evaluate the surgical techniques and 2-year follow-up results of Mast Quadrant-assisted modified transforaminal lumbar interbody fusion (TLIF).Methods From September 2006 to October 2008,54 patients with single-level lumbar degeneration disease were treated by Mast Quadrantassisted modified TLIF.Under the guidance of C-arm,the Mast Quadrant's retractor was placed and the lower articular process of the upper vertebrae and 1/2-2/3 of the lamina,flavum ligament and hyperplastic cohesive part of the lower articular process were removed,the nerve roots and the central canal were decompressed.After cleaning up intervertebral disc space,bone grafting and pedicle screw fixation were achieved.Visual analogue scale(VAS) and Oswestry disability index(ODI) results,as well as the fusion rate at the last follow-up were analyzed.Results All patients were treated by Mast Quadrant-assisted modified TLIF,in which 51 patients were followed up for 2 years.An average operating time was (178.7±63.2) min,and an average blood loss was (224.2±136.5) ml; an average postoperative drainage loss was (117.2±91.4) ml,and an average postoperative stay was (5.8±3.6) d.There were statistic significances between pre- and post-operative ODI and VAS scores,respectively.At last follow-up,51 patients were achieved radiographic fusion without internal fixation failure and other complications.Conclusion Mast Quadrant-assisted modified TLIF had a good vision,was relatively safe and easy to be acceptable by surgeons,and which had a good clinical results for the patients with single-level lumbar degenerative disease.%目的 总结Mast Quadrant辅助下工作区域内移改良经椎间孔腰椎椎体间融合术(transforaminal lumbar interbody fusion,TLIF)的手术操作技巧及其短期随访结果.方法 2006年9月至2008年10月,Mast Quadrant拉钩辅助下改良TLIF治疗54例腰椎单节段退变性疾病患者.术中经“C”型臂X线机透视定位病变节段,依次置入Mast Quadrant拉钩并适度纵向扩张,充分显露关节突关节和椎板,直视下咬除患侧上位椎体的下关节突及椎板下1/2～2/3、黄韧带及下位椎体上关节突增生内聚部分,减压神经根管及中央管,处理椎间隙行椎体间植骨融合,进一步行椎弓根螺钉固定.统计该组患者的手术操作时间、术中失血量、术后引流量、术后住院时间、手术相关并发症;术后3、6、12、24个月随访,记录患者疼痛视觉模拟评分法(visual analogue scale,VAS)、Oswestry功能障碍指数(Oswestry disability index,ODI),以及末次随访影像学融合率.结果 54例患者均顺利完成手术,51例患者获得随访.平均手术时间(178.7±63.2) min,平均术中失血量为(224.2±136.5) ml,术后引流量平均(117.2±91.4) ml,平均术后住院时间(5.8±3.6)d.患者术后各随访时间点ODI、VAS与术前相比差异均有统计学意义.末次随访时51例患者均达到影像学融合标准,未发现断钉、断棒等内固定相关并发症.结论 Mast Quadrant辅助下改良TLIF为直视下操作,较为安全,易于掌握;对单节段腰椎退变性疾病患者具有良好的临床治疗效果.