摘要目的 探讨改良经椎间孔椎体间融合术治疗腰椎退变性疾病的临床疗效.方法 2007年6月至2009年5月对62例腰椎退变性疾病患者行改良经单侧椎间孔椎体间植骨融合,相应节段椎弓根钉内固定术.其中腰椎间盘突出合并腰椎不稳28例,腰椎间盘突出合并椎管狭窄27例,退变性滑脱7例.累及单节段48例,累及双节段14例.通过观察融合情况,记录术前、术后3个月和末次随访时的视觉模拟评分(VAS)和日本矫形外科学会(JOA)评分判定治疗效果.结果 62例患者均获得随访,随访时间15～30(22.77±3.82)个月.无神经损伤、脑脊液漏、感染及椎弓根钉断裂等并发症.术后1年椎体间融合率为96.8%.依据JOA评分,优34例,良24例,可4例,差0例,优良率为93.5%(58/62).术后VAS和JOA评分与术前比较差异有统计学意义(P＜0.05),术后3个月VAS和JOA评分与末次随访时比较差异无统计学意义(P＞0.05).结论 改良经椎间孔椎体间融合术在充分减压同时能减少进入椎管带来的并发症,临床疗效好,是治疗腰椎退变性疾病的有效术式.

abstractsObjective To investigate the chnical effect of modified transforaminal lumbar interbody fusion (TLIF) on the treatment of lumbar degenerative disease. Methods Sixty-two patients with lumbar degenerative disease were treated by the modified TLIF from June 2007 to May 2009. The preoperative diagnosis was lumbar intervertebral disc herniation with spinal instability (28 cases), lumbar intervertebral disc herniation with lumbar stenosis (27 cases ), degenerative spondylohsthesis (7 cases ). Forty-eight cases were single-level and 14 cases were two-level. The patients were evaluated by observing the fusion rate and comparing the visual analog score( VAS ) and Japanese orthopaedics association (JOA) score of preoperation with those of postoperation. Results All the patients were followed up from 15 to 30 (22.77 ± 3.82)months,no nerve injury,leakage of cerebralspinal,infection,the broken of pedical screws and other complications. The fusion rate of segment was 96.8% at the follow-up after 1 year postoperatively. Judgement by JOA score,the rate of improvement was 93.5%(58/62),excellent in 34 cases,good in 24 cases,fair in 4 cases. The postoperative value of V AS and JOA score were higher than those of preoperation (P ＜ 0.05 ), the values when follow-up of 3 months was performed had no statistic al difference with those of final follow-up (P＞0.05). Conclusion The modified TLIF with fully decompression while reducing the accessing spinal canal complications have good clinical efficacy in treating lumbar degenerative disease.