CAJ | 학술논문

目的分析用改良的经椎间孔椎体间融合术(TLIF)治疗下腰椎退行性疾病的临床效果.方法从2005年2月-2009年2月,我科对26例患下腰椎退行性疾病的患者采用椎管扩大减压后行TLIF方法融合固定,术中先切除TLIF侧下关节突、上关节突内上侧部分,并将该椎管节段扩大减压,使硬膜及神经根完全松解,满意后按照常规方法完成TLIF.结果 26例病人均获得随访,时间12～36个月,平均20.6个月,无术口感染,无椎弓根钉松脱、断裂,无Cake移位.1例术后出现下肢麻木疼痛,对症治疗3个月后明显减轻;1例术后18月融合节段未见骨性连接,骨融合率96.2%.椎间隙后缘高度由术前平均(5.12±0.58)mm,术后1周内复查为(9.86±0.71)mm(P<0.01),末次随访(9.67±0.69)mm(P<0.01).腰椎脊柱前凸得到明显的改善;末次随访时视觉评分,由术前的(7.99±0.74)分改善到(1.95±0.39)分(P<0.01).按改良的Prolo功能评分,优14例,良9例,可2例,差1例,优良率88.5%.结论改良的TLIF方法扩大了手术适应症,使操作更加安全,减少了并发症的发生,用于治疗并发有椎管狭窄及双侧神经根孔狭窄的退行性下腰椎疾病疗效满意.
목적 분석용개량적경추간공추체간융합술(TLIF)치료하요추퇴행성질병적림상효과.방법 종2005년2월-2009년2월,아과대26례환하요추퇴행성질병적환자채용추관확대감압후행TLIF방법융합고정,술중선절제TLIF측하관절돌、상관절돌내상측부분,병장해추관절단확대감압,사경막급신경근완전송해,만의후안조상규방법완성TLIF.결과 26례병인균획득수방,시간12～36개월,평균20.6개월,무술구감염,무추궁근정송탈、단렬,무Cake이위.1례술후출현하지마목동통,대증치료3개월후명현감경;1례술후18월융합절단미견골성련접,골융합솔96.2%.추간극후연고도유술전평균(5.12±0.58)mm,술후1주내복사위(9.86±0.71)mm(P<0.01),말차수방(9.67±0.69)mm(P<0.01).요추척주전철득도명현적개선;말차수방시시각평분,유술전적(7.99±0.74)분개선도(1.95±0.39)분(P<0.01).안개량적Prolo공능평분,우14례,량9례,가2례,차1례,우량솔88.5%.결론 개량적TLIF방법확대료수술괄응증,사조작경가안전,감소료병발증적발생,용우치료병발유추관협착급쌍측신경근공협착적퇴행성하요추질병료효만의.
Objective To analyze the clinical effectiveness of modified transforaminal lumbar interbody fusion(TLIF) to treat the lower lumbar retrogression. Methods From Feb. 2005 to Feb.2009,26 cases were treated by TLIF after laminoplasty and decompression, removed the superior articular process and inside and upside part of inferior articular process, enlarged the canal for decompression,released the spinal cord and nerve roots completely. The conventional TLIFs was completed then. Results All the 26 cases were followed up 12 to 36 months, 20.6 months in average. There were no infection,loosening and breakdown of pedicle nails , no movement of Cake. There was numb and pain of lower limbs of 1 case, which was relieved obviously after 3 months of symptomatic treatment, and non-union of fused lumbar of another cases after 18 months. The fusion rate was 96.2%.The height of afterskirt of intervertebral space rised from (5.12 ± 0.58)mm before operation to (9.86 ± 0.71)mm at 1 week after operation, and became (9.67 ± 0.69)mm at the last follow-up(P＜0.01 ). At the last follow-up, the visual scales of lumbar lordosis were improved to (1.95 ± 0.39) from(7.99 ± 0.74 )before operation(P＜0.01). According to modified Prolo functional score, 14 cases were rated as excellent, 9 as good,2 as fair and 1 as poor, the rate of excellence and good was 88.5%.Conclusion The modified TLIF can expand the indication of operation,ensure the operation safer, decease the complication, and be satisfatory to treat the lower lumbar retrogression with spinal stenosis and bilateral intervertebral foramen stenosis.