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1、Short-TermResultsofTransforaminalLumbarInterbodyFusionUsingPedicleScrewwithCorticalBoneTrajectoryComparedwithConventionalTrajectoryDepartmentofOrthopedicSurgery,AkitaUniversityGraduateSchoolofMedicine,Akita,Japan使用皮質(zhì)骨螺釘植入與傳統(tǒng)螺釘植入在TLIF手術(shù)中的短期結(jié)果Introduction前言Theclinicalresultsoftransforaminallumbarin
2、terbodyfusion(TLIF)havebeenfavorablefordegenerativespondylolisthesis,kyphoscoliosis,andinstabilityofthelumbarspine.However,therehasbeenconcernregardingpediclescrewplacementduringTLIF。TLIF手術(shù)的臨床效果已經(jīng)被很好的運用于腰椎退變性滑脫、脊柱側(cè)后凸畸形及腰椎不穩(wěn)。然而,TLIF手術(shù)過程中已經(jīng)有關(guān)于椎弓根螺釘?shù)亩ㄎ?。Exposurelateraltothefacetjointtoinsertapedicles
3、crewrequiresarelativelylongincisionandmuscledissection,whichmayberelatedtopostoperativelowbackpainfrominjurytotheposteromedialbranchofthenerverootcrossingthefacetjointanddamagetotheexposedandretractedbackmusculature.Tominimizetheincisionandmuscledissectionandthusreducetheseproblems,TLIFwithminima
4、llyinvasivepediclescrewinsertion(M-TLIF)andTLIFwithpercutaneouspediclescrewinsertion(P-TLIF)havebeendeveloped.暴露側(cè)方到關(guān)節(jié)突關(guān)節(jié)去植入椎弓根螺釘需要相當(dāng)長的切口和肌肉切開。這種手術(shù)因損傷穿過關(guān)節(jié)突的神經(jīng)根后支及暴露過程中損傷背肌肉組織而引起后背痛。通過縮小切口及減少肌肉組織的剝離去減少這些問題,TLIF用于微創(chuàng)椎弓根螺釘植入和經(jīng)皮椎弓根螺釘植入已經(jīng)被很好的運用。However,severalclinicalconcerns,suchaslowbackpain,learningc
5、urve,radiationexposure,andincorrectpediclescrewplacement,havealsobeenassociatedwithM-TLIFandP-TLIF。然而,在M-TLIF及P-TLIF手術(shù)中,幾個臨床上關(guān)注點諸如下腰痛,長的學(xué)習(xí)曲線,射線的暴露,以及椎弓根螺釘位置植入不正確也已經(jīng)被證實發(fā)生。Anewtrajectoryforpediclescrewinsertionofpediclescrewplacement,thecorticalbonetrajectory(CBT),wasreportedbySantonietal.in2009and
6、mayaddresstheseproblems.Thenewtrajectorywasfrommedialtolateralandcranialtocaudal;thisdoesnotrequirewideexposureofthebackmuscleandthusreducesoperativeinvasioncomparedwithconventionalorpercutaneouspediclescrewinsertion.在2009年,一種新的全皮質(zhì)椎弓根螺釘植入方法被Santoniet等報道,并且可能解決一些問題。新的全皮質(zhì)螺釘植入是從內(nèi)向外,從頭向尾,這種方法與傳統(tǒng)或者經(jīng)皮椎
7、弓根螺釘植入相比不需要廣泛剝離后背肌肉組織和減少手術(shù)損傷However,thedifferencesinoperativeinvasion,accuracyofpediclescrewinsertion,andpostoperativefusionratebetweenTLIFwithCBT(CBT-TLIF)andothermethodsofpediclescrewplacement,suchasM-TLIFandP-TLIF,r