CAJ | 학술논문

目的观察经椎间孔腰椎椎体间融合(TLIF)入路减压结合椎弓根螺钉固定治疗老年退变性腰椎管狭窄症的疗效.方法 2007年1月至2010年8月我院收治老年腰椎管狭窄症患者75例,男28例,女47例.手术采用TLIF入路,凿除部分关节突关节,切除增厚的黄韧带,暴露椎间孔,切除椎体后缘骨赘及突出的椎间盘,使中央椎管及神经根管管径扩大.减压后结合椎弓根螺钉固定,同时行后外侧或椎间融合.术前、术后1d、3个月随访采用JOA进行评分,根据X线片评价椎间隙高度的变化及椎间融合情况.结果 75例均获随访,随访时间为6～36个月,平均12个月.临床疗效:术后3个月JOA评分(21.08±3.60)分,与术前(10.91±2.23)分相比,差异有统计学意义(t=20.79,P＜0.05)；术后1dJOA评分(22.72±3.26)分,与术前(10.91±2.23)分相比,差异有统计学意义(t=25.89,P＜0.05).随访3个月JOA评分改善率(88.6±10.8)％,优良率98％.影像学评价:术后随访X线片示所有病例均无腰椎不稳征象,无内固定断裂,植骨融合良好,融合器移位2例,无明显神经症状.结论经TLIF人路扩大减压结合椎弓根螺钉固定融合可有效保留腰椎后方韧带复合体,使腰椎稳定性的破坏减至最小,椎管减压充分,术后组织愈合好,并发症少,出血少,术后患者下床早,是治疗老年人腰椎管狭窄症的一个安全选择.
목적 관찰경추간공요추추체간융합(TLIF)입로감압결합추궁근라정고정치료노년퇴변성요추관협착증적료효.방법 2007년1월지2010년8월아원수치노년요추관협착증환자75례,남28례,녀47례.수술채용TLIF입로,착제부분관절돌관절,절제증후적황인대,폭로추간공,절제추체후연골췌급돌출적추간반,사중앙추관급신경근관관경확대.감압후결합추궁근라정고정,동시행후외측혹추간융합.술전、술후1d、3개월수방채용JOA진행평분,근거X선편평개추간극고도적변화급추간융합정황.결과 75례균획수방,수방시간위6～36개월,평균12개월.림상료효:술후3개월JOA평분(21.08±3.60)분,여술전(10.91±2.23)분상비,차이유통계학의의(t=20.79,P＜0.05)；술후1dJOA평분(22.72±3.26)분,여술전(10.91±2.23)분상비,차이유통계학의의(t=25.89,P＜0.05).수방3개월JOA평분개선솔(88.6±10.8)％,우량솔98％.영상학평개:술후수방X선편시소유병례균무요추불은정상,무내고정단렬,식골융합량호,융합기이위2례,무명현신경증상.결론 경TLIF인로확대감압결합추궁근라정고정융합가유효보류요추후방인대복합체,사요추은정성적파배감지최소,추관감압충분,술후조직유합호,병발증소,출혈소,술후환자하상조,시치료노년인요추관협착증적일개안전선택.
Objective To observe the efficacy of extensive decompression through transforaminal lumbar interbody fusion (TLIF) pathway combined with pedicle screw fixation on treating degenerative lumbar stenosis in the dderly.Methods Seventy-five elderly patients (28 males and 47 females) with degenerative lumbar stenosis were treated with extensive decompression through transforaminal pathway at our hospital from Jan.2007 to Aug.2010.The operation is through the TLIF pathway to resect part of the articular facet,and expose unilaterally the intervertebral vertebral foramen.Decompression of the vertebral canal was conducted by removing the disc.In the end,we performed posterolateral fixation with pedicle screw and placement of bone graft in posterolateral part of the lumbar or did the interbody fusion.JOA scores were obtained before and 1 day after operation and in 3 month follow-up consultation.The intervertebral height and bone fusion were observed by X ray.Results The follow-up period of the 75 patients was 6-36 months with an average of 12 months.There was significant difference (t =20.79,P ＜ 0.05 ;t =25.89,P ＜ 20.05) in JOA score between 3 month follow-up (21.08 ± 3.60) and preoperation (10.91 ± 2.23),between 1 d follow-up (22.72 ± 3.26) and preoperation (10.91 ±2.23),respectively.The rate of improvement was (88.6 ± 10.8)％,with 98％ of "excellent" or "good" in 3-month follow-up.Lumbar plane films showed neither instability or internal fixation loosening,breakage or distortion in follow-up consultation.There were 2 cases in whom Cage dislocation occurred without any neurological symptoms.Conclusion Extensive decompression through TLIF pathway combined with pedicle screw fixation is an efficacious method of treating degenerative lumbar stenosis in elderly patients.This method can retain the structure of lumbar posterior complex,reduce the risk of low back pain.It is a safe choice for treatment of degenerative lumbar stenosis in the elderly.