经椎间孔融合联合单侧椎弓根钉内固定治疗高位腰椎椎间盘突出症

目的观察经椎间孔融合(transforaminal lumbar interbody fusion,TLIF)联合单侧椎弓根钉内固定治疗高位腰椎椎间盘突出症的临床疗效。方法 2006年3月～2008年12月收治且获得随访的单间隙高位腰椎椎间盘突出症患者23例,其中L1/L25例,L2/L38例,L3/L410例。均采用经椎间孔单枚Cage植骨融合并单侧椎弓根螺钉内固定术治疗。根据日本骨科学会(Japanese Orthopaedic Association,JOA)(29分)评分法评估术后疗效,计算改善率和优良率,观察植骨融合情况。结果 1例硬脊膜撕裂,1例椎弓根螺钉位置偏斜。随访23～52个月,平均40.2个月,JOA评分由术前10.04±2.12提高到随访23个月时的24.13±3.39,优良率为91.3%。23个月时骨性融合率为95.8%。结论TLIF联合单侧椎弓根钉内固定治疗高位腰椎椎间盘突出症具有不破坏健侧结构,手术和住院时间短,内固定费用低,神经功能康复好的优点,是治疗高位腰椎椎间盘突出症可供选择的较好方法。

Transforaminal lumbar interbody fusion combined unilateral pedicle screw fixation for upper lumbar disc herniation

Objective To evaluate the clinical effect of unilateral transforaminal lumbar interbody fusion（TLIF） combined unilateral pedicle screw fixation for the treatment of upper lumbar disc herniation. Methods From Mar 2006 to December 2008, 23 cases with upper lumbar disc herniation undewent laminectomy, transforamina discectomy and lumbar interbody fusion were reviewed retrospectively. The involved level included LI/L2 in 5 cases, L2/Iz in 8 cases and L3/L4 in 10 cases. All cases were treated by single cage combined unilateral pedicle screw placement. Japanese Orthopaedic Association （JOA） scores （29 scores） were used to assesse the clinical outcome and the excellent rate, improve rate and fusion status were reviewed retrospectively. Results Complications included dural tear （ 1 cases） and pedicle screw deviating （ 1 cases）. The mean follow-up time was 40.2 months（24 -52 months）. The preoperative JOA score was 10.04 ±2.12, and 24.13 ±3.39 at 23 months postoperative, excellent rate was 91.3%. Bone fusion rate was 95.8%. Conclusion Unilateral transforaminal lumbar interbody fusion combined unilateral pediele screw fixation has the advantages of small incision, little bleeding, no destruction of the contralateral structure, short operating time or hospital stay, low medical device expenses and good recovery.