摘要
目的探讨改良经椎间孔腰椎椎体间融合术（TLIF）治疗老年腰椎管狭窄症并不稳的可行性和临床疗效。方法对2011年6月至2012年12月我院确诊为老年腰椎管狭窄症并不稳并行改良经椎间孔腰椎椎体间融合手术治疗的45例患者进行回顾性分析，平均（70．6±4．0）岁。记录手术时间、出血量及并发症发生情况；于术前、术后3个月及末次随访时，采用疼痛视觉模拟评分（VAS）结合日本骨科学会评分（JOA）评价临床疗效；采用Brantigan-Steffe椎间融合评估标准评定椎问椎骨融合情况。结果45例患者均顺利完成手术，手术时间1.0～185min，平均（126±23）min，术中出血180～550ml，平均（272±89）ml，未发生硬脊膜撕裂、神经根损伤及深部感染等严重并发症。术后45例均获随访，随访时间12～30个月，平均（20．6±5．8）个月。术前腰痛VAS评分为（4．8±1．7）分，术后3个月及末次随访时分别为（1．6±0．5）分和（1．3±0．3）分，与术前比较明显改善（F=68．35，P=0．00）；术前下肢疼痛VAS评分为（6．7±1．6）分，术后3个月及末次随访时分别为（1．2±0．5）分和（0．6±0．3）分，与术前比较明显改善（F=98．58，P=0．00）；术前JOA评分为（13．2±4．9）分，术后3个月及末次随访时分别为（23．8±4．O）分和（24．1±4．2）分，与术前相比明显提高，差异有统计学意义（F=89．73，P=0．00）。术后1年复查腰椎x片，所有患者均达到影像学融合标准，无椎弓根螺钉断裂、松动及椎间融合器移位等内植物失败发生。结论改良TLIF技术的优点是手术创伤较小，术中减压彻底，并对神经结构干扰小，是治疗老年腰椎管狭窄症并不稳较为理想的手术方式。
Objective To explore the feasibility and clinical efficacy of modified transforaminal lumbar interbody fusion for the treatment of lumbar spinal stenosis with lumbar instability in the elderly. Methods Retrospective study was done on 45 elderly patients diagnosed as lumbar spinal stenosis with lumbar instability treated by modified transforaminal lumbar interbody fusion from June 2011 to December 2012. There were 25 males and 20 females aged from 65 to 78 years [mean （70.6 4.0） years]. The operation time, blood loss, and complications were recorded and analyzed. The visual analog scale （VAS） score, and Japanese Orthopaedic Association （JOA） score were used to assess clinical outcomes before and 3 months after treatment and at the last follow-up. According to the criteria of Brantigan-Steffe, intervertebral fusion was evaluated. Results The operation of 45 patients was successful, and there were no severe complication. The average operative time was （126 23） rain, （range, 100 - 185 min）, and the average amount of blood loss was （272±89） ml （range, 180-550 ml）. There was no injury of nerve root, dural tear, or deep infection. All patients were followed up for 12 months to 30 months with an average of （20.6±5.8） months. The VAS score of low back pain was decreased from （4.8± 1.7） before operation to （1.6 ±0.5） at 3 months after operation and （1.3±0.3） at last follow-up. The VAS score of leg pain was decreased from （6.7±1.6） before operation to （1.2±0.5） at 3 months after operation and （0. 6±0.3） at last follow-up. The JOA score was increased from （13.2±4.9） before operation to （23.8±4.0） at 3 months after operation and （24.1 4.2） at last follow up. There were significant differences in the VAS score and JOA score between pre- and post-operation （F= 68.35, 98. 58, 89. 73, all P〈0.05）, but no significant difference between 3 months after operation and final follow-up （all P〈 0.05）. We observed no pedicle screw loosening, breaking, orany pullingout of intervertebral fusion cage. All patients showed evidence of fusion in each operated segment according to the criteria of Brantigan- Steffe. Conclusions Modified transforaminal lumbar interbody fusion has the advantages including less invasion, sufficient decompression, and less interference to neural structures, and it may provide an ideal surgical method for lumbar spinal stenosis with lumbar instability in the elderly.
出处
《中华老年医学杂志》
CAS
CSCD
北大核心
2014年第6期626-629,共4页
Chinese Journal of Geriatrics
关键词
腰椎
脊柱融合术
Lumbar vertebrae
Spinal fusion
