改良 TLIF 联合单侧椎弓根钉内固定治疗腰椎间盘突出症

摘要

目的：探讨改良经椎间孔椎间融合术（transforaminal lumbar interbody fusion，TLIF）联合单侧椎弓根螺钉内固定治疗腰椎间盘突出症的手术方法和疗效。方法自2010年12月至2014年4月，采用改良 TLIF 手术治疗腰椎间盘突出症患者62例，其中采用单边固定28例，双边固定34例。单边固定组：男19例，女9例；年龄28~57岁，融合节段：L1~21例，L2~31例，L3~42例，L4~518例，L5 S16例。双边固定组：男22例，女12例；年龄32~59岁，融合节段：L1~21例，L2~32例，L3~43例，L4~519例，L5 S19例。分析两组患者的手术时间、术中出血量、术后引流量。采用疼痛视觉模拟量表（visual analogue scale，VAS）评分、日本骨科学会（Japanese orthopaedic association，JOA）评分和 Oswestry 功能障碍指数（Oswestry disability index，ODI）来评估两组患者的临床效果，并观察术后并发症情况。结果所有患者随访时间平均为16.7个月，单边组的手术时间、出血量和术后引流量明显少于双边组，差异有统计学意义（P ﹤0.05）。两组内术后 VAS 评分、ODI 评分和 JOA 评分与术前比较差异有统计学意义（P ﹤0.01），但两组之间的各评分比较差异无统计学意义（P ﹥0.05）。结论改良 TLIF 手术联合单侧椎弓根螺钉内固定治疗腰椎间盘突出症，具有创伤小、出血少、不破坏对侧结构、手术时间短等优势，术后功能恢复满意。%Objective To explore the clinical application and result of modified transforaminal lumbar interbody fusion (TLIF)with unilateral pedicle screw fixation for the treatment of lumbar intervertebral disc herniation. Methods From De-cember 2010 to April 2014,62 patients with lumbar intervertebral disc herniation were treated by modified TLIF. There were 28 patients in unilateral fixation group,19 males and 9 female,aged from 28 to 57 years old. Fusion located in L1 ~ 2 in 1 case,L2 ~ 3 in 1 case,L3 ~ 4 in 2 cases,L4 ~ 5 in 18 cases,L5 S1 in 6 cases. There were 34 patients in bilateral fixation group,including 22 males and 12 females,aged from 32 to 59 years old. Fusion located in L1 ~ 2 in 1 cases,L2 ~ 3 in 2 cases,L3 ~ 4 in 3 cases,L4 ~ 5 in 19 cases,L5 S1 in 9 cases. Operation time,intraoperative blood loss,postoperative drainage were analyzed between two groups. The clinical outcomes of 2 groups were assessed by visual analog scale(VAS)scores,Oswestry and Japanese Orthopedic Asso-ciation(JOA)scores. Post-operative complicaions were monitored. Results All patients were followed-up for 16. 7 months,op-eration time,blood loss and postoperative drainage of unilateral group reduced significantly compared with bilateral fixation group(P ﹤ 0. 05). In addition,statistical significance was found with respect to postoperative scores of VAS scores,ODI and JOA scores compared with preoperative data( P ﹤ 0 . 0 1 ),whereas no statistical significance between the two groups( P ﹥0. 05). Conclusion The modifled TLIF with unilateral pedicle screw fixation for the treatment of lumbar intervertebral disc herniation is an effective method,which has not only some traditional advantages,such as smaller trauma,less bleeding,no de-struction of the contralateral structures,short operation time,but also more satisfactory function recovery.