Mao Ke-ya, Wang Yan, Xiao Song-hua, Zhang Yong-gang, Liu Bao-wei, Wang Zheng, Zhang Xi-Feng, Cui Geng, Zhang Xue-song, Li Peng, Mao Ke-zheng
Department of Orthopedics, Chinese People's Liberation Army General Hospital, Beijing 100853, China.
Zhonghua Wai Ke Za Zhi. 2013 Aug;51(8):723-7.
To investigate the feasibility of minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) using hybrid internal fixation of pedicle screws and a translaminar facet screw for recurrent lumbar disc herniation.
From January 2010 to December 2011, 16 recurrent lumbar disc herniation patients, 10 male and 6 female patients with an average age of 45 years (35-68 years) were treated with unilateral incision MIS-TLIF through working channel. After decompression, interbody fusion and fixation using unilateral pedicle screws, a translaminar facet screw was inserted from the same incision through spinous process and laminar to the other side facet joint. The results of perioperative parameters, radiographic images and clinical outcomes were assessed. The repeated measure analysis of variance was applied in the scores of visual analogue scale (VAS) and Oswestry disablity index (ODI).
All patients MIS-TLIF were accomplished under working channel including decompression, interbody fusion and hybrid fixation without any neural complication. The average operative time was (148 ± 75) minutes, the average operative blood loss was (186 ± 226) ml, the average postoperative ambulation time was (32 ± 15) hours, and the average hospitalization time was (6 ± 4) days. The average length of incision was (29 ± 4) mm, and the average length of translaminar facets screw was (52 ± 6) mm. The mean follow-up was 16.5 months with a range of 12-24 months. The postoperative X-ray and CT images showed good position of the hybrid internal fixation, and all facets screws penetrate through facets joint. The significant improvement could be found in back pain VAS, leg pain VAS and ODI scores between preoperative 1 day and postoperative follow-up at all time-points (back pain VAS:F = 52.845, P = 0.000;leg pain VAS:F = 113.480, P = 0.000;ODI:F = 36.665, P = 0.000).
Recurrent lumbar disc herniation could be treated with MIS-TLIF using hybrid fixation through unilateral incision, and the advantage including less invasion and quickly recovery.
探讨采用椎弓根螺钉与经椎板关节突螺钉混合内固定的微创经椎间孔腰椎椎间融合术（MIS-TLIF）治疗复发性腰椎间盘突出症的可行性。
2010年1月至2011年12月，对16例复发性腰椎间盘突出症患者（男10例，女6例，平均年龄45岁，35 - 68岁）采用经工作通道单侧切口行MIS-TLIF治疗。减压、椎间融合并使用单侧椎弓根螺钉固定后，经同一切口从棘突和椎板向另一侧关节突关节插入经椎板关节突螺钉。评估围手术期参数、影像学图像及临床疗效。对视觉模拟评分（VAS）和Oswestry功能障碍指数（ODI）评分采用重复测量方差分析。
所有患者均在工作通道下完成MIS-TLIF，包括减压、椎间融合及混合固定，无任何神经并发症。平均手术时间为（148±75）分钟，平均术中出血量为（186±226）毫升，平均术后下床活动时间为（32±15）小时，平均住院时间为（6±4）天。平均切口长度为（29±4）毫米，平均经椎板关节突螺钉长度为（52±6）毫米。平均随访16.5个月，范围为12 - 24个月。术后X线和CT图像显示混合内固定位置良好，所有关节突螺钉均穿过关节突关节。在所有时间点，术前1天与术后随访时的腰痛VAS、腿痛VAS及ODI评分均有显著改善（腰痛VAS：F = 52.845，P = 0.000；腿痛VAS：F = 113.480，P = 0.000；ODI：F = 36.665，P = 0.000）。
复发性腰椎间盘突出症可采用经单侧切口混合固定的MIS-TLIF治疗，其优点包括侵袭性小、恢复快。
