CAJ | 학술논문

目的观察经椎间孔椎体间融合术(TUF)治疗腰椎滑脱症的临床疗效.方法 2009年6月至2012年6月山东枣庄矿业集团公司枣庄医院骨科应用TLIF治疗腰椎滑脱症患者42例,男18例,女24例;年龄平均48(30 ～68)岁.其中退变性腰椎滑脱16例,峡部裂性腰椎滑脱26例.按Meyerding法对滑脱分类:Ⅰ°28例,Ⅱ°12例,Ⅲ°2例.手术方法首先采用椎弓根螺钉固定,后应用TLIF行减压、椎间融合,结合椎间融合器进行撑开复位.术前、术后采用视觉模拟评分法(VAS)、Oswestry功能障碍指数(ODI)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.结果本组病例术中无并发症,随访平均19.4(9 ～36)个月.患者术后VAS评分(2.5±1.4)分及末次随访评分(2.3±1.6)分较术前(7.1±0.9)分显著降低(P＜0.05)分,术后ODI评分(24.2±11.4)及末次随访评分(20.9±10.0)较术前(68.4±12.8)显著降低(P＜0.05),术后及末次随访VAS、ODI评分差异无统计学意义(P＞0.05).术后手术节段椎间隙高度(9.68±1.62)及末次随访手术节段椎间隙高度(9.3±1.3)较术前(8.3±1.3)显著增大(P＜0.05),但末次随访椎间隙高度较术后降低,差异有统计学意义(P=0.001).1例出现融合器移位,无神经症状,椎弓根系统无松动及断裂,椎间融合率为100％,植骨融合时间平均为6.5个月.术后无明显并发症.结论应用TLIF行有效的减压及椎间融合,结合后路内固定,达到稳定椎体、减轻临床症状的治疗腰椎滑脱症的目的.
목적 관찰경추간공추체간융합술(TUF)치료요추활탈증적림상료효.방법 2009년6월지2012년6월산동조장광업집단공사조장의원골과응용TLIF치료요추활탈증환자42례,남18례,녀24례;년령평균48(30 ～68)세.기중퇴변성요추활탈16례,협부렬성요추활탈26례.안Meyerding법대활탈분류:Ⅰ°28례,Ⅱ°12례,Ⅲ°2례.수술방법수선채용추궁근라정고정,후응용TLIF행감압、추간융합,결합추간융합기진행탱개복위.술전、술후채용시각모의평분법(VAS)、Oswestry공능장애지수(ODI)진행평분,근거X선편평개추간극고도적변화급추간융합정황.결과 본조병례술중무병발증,수방평균19.4(9 ～36)개월.환자술후VAS평분(2.5±1.4)분급말차수방평분(2.3±1.6)분교술전(7.1±0.9)분현저강저(P＜0.05)분,술후ODI평분(24.2±11.4)급말차수방평분(20.9±10.0)교술전(68.4±12.8)현저강저(P＜0.05),술후급말차수방VAS、ODI평분차이무통계학의의(P＞0.05).술후수술절단추간극고도(9.68±1.62)급말차수방수술절단추간극고도(9.3±1.3)교술전(8.3±1.3)현저증대(P＜0.05),단말차수방추간극고도교술후강저,차이유통계학의의(P=0.001).1례출현융합기이위,무신경증상,추궁근계통무송동급단렬,추간융합솔위100％,식골융합시간평균위6.5개월.술후무명현병발증.결론 응용TLIF행유효적감압급추간융합,결합후로내고정,체도은정추체、감경림상증상적치료요추활탈증적목적.
Objective To explore the clinical outcomes of transforminal lumbar interbody fusion (TLIF) technique in treatment of lumbar spondylolisthesis.Methods From June 2009 to June 2006,42 patients underwent TLIF.There were 18 males and 24 females with an average age of 48 (30-68) years.The preoperative diagnoses included lumber degenerative spondylolisthesis (n =16) and lumbar isthmic spondylolisthesis (n =26).According to the Meyerding standard,28 cases were classified as degree Ⅰ,12 as degree Ⅱ and 2 as degree Ⅲ.Posterolateral fixation with pedicle screw and decompression,interbody fusion through TLIF technical plus cage for distraction reduction were employed.The evaluation standards of visual analog scale (VAS) and Oswestry disability index (ODI) were applied to evaluate the therapeutic outcomes.Intervertebral height and bone fusion were observed by radiology.Results All patients underwent surgery safely without any severe complication.The average follow-up period was 19.4 (9-36) months.Compared with preoperative parameters (7.07 ± 0.92),the postoperative scores of VAS decreased significantly (2.52 ± 1.37) and at the final follow-up (2.26 ± 1.61) (P ＜ 0.05) ; compared with preoperative parameters (68.43 ± 12.81),the postoperative scores of ODI decreased significantly (24.19 ± 11.44) and at the final follow-up (20.86 ± 9.97) (P ＜ 0.05) and no significant difference in VAS or ODI score existed between post-operation and last follow-up (P ＞ 0.05).Compared with preoperative parameters (8.25 ± 1.27),the postoperative height of intervertebral space increased significantly (9.68 ± 1.62) and at the final follow-up (9.33 ± 1.25) (P ＜ 0.05).And intervertebral height decreased at the final follow-up.There was significant difference between post-operation and last follow-up (P =0.001).At the follow-up of 6.5 months postoperatively,all operated segments achieved fusion standard and no broken screw.There was 1 case of cage dislocation.Conclusion TLIF may be performed easily and safely with fewer complications.And its efficacies are satisfactory for patients with lumbar spondylolisthesis.