经椎间孔行腰椎间融合联合单侧椎弓根螺钉固定术治疗高位腰椎间盘突出症疗效分析

摘要

Objective To investigate the clinical effect of transforaminal lumbar interbody fusion (TLIF) combined with unilateral pedicle screw fixation for upper lumbar disc herniation. Methods Retrospectively analysed the clinical data of 16 patients with upper lumbar disc herniation from Jun 2009 to Feb 2013 in our hospital, who were treated with transforaminal lumbar interbody fusion combined with unilateral pedicle screw fixation;using the visual analogue scale assessed the pain degree of patients at admission and after operation; assessed the clinical efficacy at last follow-up according to the modified MacNab criteria and observed intervertebral fusion. Results 16 patients were followed up 12 to 52 months (average 24.2 months) after surgery. All the patients had no nerve damage and leakage of cerebrospinal fluid complications. VAS score at different postopera-tive periods had significant difference compared with the VAS score before operation (P<0.01). According to the modified Mac-Nab criteria,the excellent and good rate was 93.75%. X-ray examination showed that there were no internal fixation failure and lumbar interbody non-fusion at the last follow-up. Conclusion Transforaminal lumbar interbody fusion combined with uni-lateral pedicle screw fixation has satisfied effect in the treatment of upper lumbar disc herniation,and has the advantages of small trauma,less complications,low cost.%目的：探讨经椎间孔行腰椎间融合（transforaminal lumbar interbody fusion，TLIF）联合单侧椎弓根螺钉固定术治疗高位腰椎间盘突出症的临床疗效。方法回顾性分析2009年6月～2013年2月本院16例高位腰椎间盘突出症患者临床资料，均采用TLIF联合单侧椎弓根螺钉固定术治疗；采用腰腿痛视觉模拟评分测评入院时和TLIF联合单侧椎弓根螺钉固定术后（术后1周、1个月、3个月及末次随访）患者疼痛情况，末次随访采用改良MacNab标准评定临床疗效，并了解椎间融合情况。结果16例患者手术后随访12～52个月，平均24.2个月。所有患者均无神经损伤和脑脊液漏并发症发生。患者术后不同时期的VAS评分与术前比较差异均有显著性（P＜0.01）。采用改良MacNab 标准评价临床疗效，优良率为93.75%。末次随访时行X线检查，均无内固定失效和椎间不融合发生。结论 TLIF联合单侧椎弓根螺钉固定术治疗高位腰椎间盘突出症疗效满意，具有创伤小、并发症少、费用低的优点。