1、Page 1Short-Term Results of Transforaminal Lumbar Interbody Fusion Using Pedicle Screw with Cortical Bone Trajectory Compared with Conventional Trajectory Department of Orthopedic Surgery, Akita University Graduate School of Medicine, Akita, Japan 使用皮质骨螺钉植入与传统螺钉植入在TLIF手术中的短期结果Page 2Introduction 前言 T
2、he clinical results of transforaminal lumbar interbody fusion (TLIF) have been favorable for degenerative spondylolisthesis, kyphoscoliosis, and instability of the lumbar spine. However, there has been concern regarding pedicle screw placement during TLIF。TLIF手术的临床效果已经被很好的运用于腰椎退变性滑脱、脊柱侧后凸畸形及腰椎不稳。然而，
3、TLIF手术过程中已经有关于椎弓根螺钉的定位。Page 3Exposure lateral to the facet joint to insert a pedicle screw requires a relatively long incision and muscle dissection, which may be related to postoperative low back pain from injury to the posteromedial branch of the nerve root crossing the facet joint and damage to t
4、he exposed and retracted back musculature. To minimize the incision and muscle dissection and thus reduce these problems, TLIF with minimally invasive pedicle screw insertion (M-TLIF) and TLIF with percutaneous pedicle screw insertion (P-TLIF) have been developed.暴露侧方到关节突关节去植入椎弓根螺钉需要相当长的切口和肌肉切开。这种手术
5、因损伤穿过关节突的神经根后支及暴露过程中损伤背肌肉组织而引起后背痛。通过缩小切口及减少肌肉组织的剥离去减少这些问题，TLIF用于微创椎弓根螺钉植入和经皮椎弓根螺钉植入已经被很好的运用。Page 4However, several clinical concerns, such as low back pain, learning curve, radiation exposure, and incorrect pedicle screw placement, have also been associated with M-TLIF and P-TLIF。然而，在M-TLIF及P-TLIF手术
6、中，几个临床上关注点诸如下腰痛，长的学习曲线， 线的暴露， 及椎弓根螺钉位 植入不 已经被 。Page 5A new trajectory for pedicle screw insertion of pedicle screw placement, the cortical bone trajectory (CBT), was reported by Santoni et al. in 2009 and may address these problems. The new trajectory was from medial to lateral and cranial to caudal
7、; this does not require wide exposure of the back muscle and thus reduces operative invasion compared with conventional or percutaneous pedicle screw insertion.在 ， 种 的 皮质椎弓根螺钉植入方 被， 些问题。 的 皮质螺钉植入，currency1，这种方 与传统“经皮椎弓根螺钉植入相不需要剥离后背肌肉组织和减少手术损伤Page 6However, the differences in operative invasion, accu
8、racy of pedicle screw insertion, and postoperative fusion rate between TLIF with CBT (CBT-TLIF) and other methods of pedicle screw placement, such as M-TLIF and P-TLIF, remain unknown. In this study, we compared the clinical and radiological results of CBT-TLIF with those of M-TLIF and P-TLIF.然而fi在
9、皮质-TLIF与fl 椎弓根螺钉植入方 ，如M-TLIF及P-TLIF相，在手术损伤，椎弓根螺钉植入 性fi 及术后 然”有结果。在这中fi T-TLIF与M-TLIF与P-TLIF在临床和学方的结果。Page 7Surgical procedures M-TLIF was performed as follows. A unilateral facetectomy was performed at the location of the symptoms to expose the intervertebral foramen via a 6-cm incision. A thorough
10、discectomy was completed and the disc space was filled with local bone graft material and an appropriate parallel Devex cage (DePuy Spine, Raynham, MA, USA) was placed.M-TLIF手术过程如下用 的切口去暴露有侧的椎 通 需要切侧小关节。椎被 切，椎 骨和 小的 。Page 8Open conventional pedicle screws were placed using the Expedium Spine System
11、(DePuy Spine) through a bilateral Wiltse approach. Under fluoroscopic guidance in a perfect posteroanterior projection, a pedicle probe was introduced into the pedicle at a 30 medial angle and the pedicle was tapped for a screw, taking care not to penetrate the medial wall.开 传统的椎弓根螺钉植入通过 侧的Wilse入 使用
12、Expedium脊柱 统。在 的后前位 下，椎弓根在 30 入，入椎弓根螺钉，术中小不要穿椎弓根。Page 9A feeler was used to identify breakage of the cortical pedicle walls, and a pedicle screw of appropriate length, as assessed on computed tomography (CT) images, was inserted. The lengths of screws were 40 or 45 mm and 6.0 or 7.0 mm in diameter.
13、Finally, under a lateral fluoroscopic view, the length and craniocaudal direction of the screws were checked (Fig. 1).入 的 的用 椎弓根损，椎弓根螺钉的 长 ，这些结果需要在T 去 。椎弓根螺钉的长 和 。后fi在侧位的 下 查植入螺钉的长 及 角 （ 1)。Page 10Fig. 1. Lateral radiographs of M-TLIF. (A) Preoperative radiograph, (B) postoperative radiograph, (C) radiograph at final follow-up. M-TLIF, transforaminal lumbar interbody fusion with minimally invasive pedicle screw insertion.
