TLIF術式在治療腰椎滑脫癥中的臨床應用研究

許張民 田少斌 牛志勇 宋俊杰 劉智深 康健 賀晉棟 王鐵錘 劉建斌 王一雄

[摘要] 目的 探討TLIF術式治療腰椎滑脫癥的臨床效果。 方法 2013年1月～2017年6月間采用該手術方式對36例患者進行手術治療。所有手術均由同一經驗豐富的術者進行，術中首先置入椎弓根螺釘，然后采用TLIF方法進行減壓，采用椎間融合器進行植骨融合。術前、術后分別記錄視覺模擬評分法（VAS）以及Oswestry功能障礙指數（ODI）；并根據術前、術后腰椎動力位X線片評價腰椎穩定性及腰椎椎間融合情況，必要時應用腰椎CT評價椎間融合情況。 結果 術后平均隨訪20（6～48）個月?；颊咝g后1周VAS評分（3.09±0.66）分，術后6個月VAS評分（2.99±0.60）分及末次隨訪VAS評分（2.81±0.68）分較術前VAS評分（6.67±1.05）分顯著降低（P<0.05）；術后1周ODI指數（28.55±6.27）%，術后6個月ODI指數（26.97±6.48）%及末次隨訪ODI指數（26.73±5.50）%較術前ODI指數（74.32±9.39）%顯著降低（P<0.05）；術后1周、6個月及末次隨訪VAS評分、ODI指數差異無統計學意義（P>0.05）；術后腰椎骨性融合時間平均8.4（3～12）個月，融合率100%。均未出現內固定物松動、斷裂、移位等，均無神經損傷癥狀。 結論 TLIF術式對于退變性和外傷性腰椎滑脫癥的治療，術后患者疼痛緩解明顯，功能滿意，復查時骨性融合率高，是一種臨床療效滿意的手術方式。

[關鍵詞] TLIF；腰椎手術；腰椎后路；椎間植骨融合；微創技術

[中圖分類號] R681.57 [文獻標識碼] B [文章編號] 1673-9701（2018）21-0067-05

[Abstract] Objective To investigate the clinical effect of TLIF operation in the treatment of lumbar spondylolisthesis. Methods From January 2013 to June 2017， 36 patients were given this surgical treatment. All surgeries were performed by the same experienced surgeon. The pedicle screw was firstly placed in the operation. Then the TLIF method was used for decompression. An interbody fusion cage was used for bone graft fusion. Visual analogue scale （VAS） and Oswestry dysfunction index（ODI） were recorded preoperatively and postoperatively. According to the preoperative and postoperative lumbar dynamic X-ray films， the lumbar stability and lumbar interbody fusion were evaluated. Lumbar CT was used to evaluate the status of intervertebral fusion. Results The average follow-up period was 20 （6-48） months after surgery. The VAS score was （3.09±0.66） points after one week of surgery. The VAS score （2.99±0.60） at 6 months after surgery and the VAS score（2.81±0.68） at the final follow-up visit were significantly lower than the preoperative VAS score （6.67±1.05） （P<0.05）； ODI index （28.55±6.27）% one week after surgery， the ODI index （26.97±6.48）% at 6 months after surgery and the ODI index（26.73±5.50）% at the final follow-up visit were significantly lower than the preoperative ODI index （74.32±9.39）% （P<0.05）； there was no statistically significant difference in VAS score and ODI index at one week， six months after surgery and at final follow-up visit （P>0.05）. Postoperative lumbar bony fusion time averaged 8.4（3-12） months and the fusion rate was 100%. No loosening， fractures， displacement of the internal fixations were observed. No nerve injury was observed. Conclusion For the TLIF operation in the treatment of degenerative and traumatic lumbar spondylolisthesis， the patients show obvious pain relief after surgery， satisfactory function， and a high rate of bone fusion at the time of re-examination. This is a surgical method with satisfactory clinical efficacy.

[Key words] TLIF； Lumbar surgery； Posterior lumbar surgery； Lumbar interbody fusion； Minimally invasive technology

隨著老齡化社會的到來，各種退行性疾病的發生率也隨之顯著增加，腰椎間盤突出癥、腰椎滑脫等疾病也呈現越來越多的趨勢。腰椎滑脫癥作為一種臨床比較常見的脊柱疾病，可能會對患者的生活和工作造成很大的影響。其病因主要包括退變性及峽部裂，部分可能為外傷性。在保守治療無效的情況下，需要依靠外科手術進行治療?！?br>