| Objective1.To explore the feasibility and safety of using large channel to complete bone window shaping and intervertebral fusion during Endo-TLIF operation;2.To observe the short-term efficacy of single fusion cage combined with unilateral translaminar facet screw fixation for degenerative lumbar instability under large channel;3.To explore the application of double fusion cage combined with bilateral translaminar facet screw.Research methodFrom June 2018 to September 2019,30 Endo-TLIF patients who were treated with single fusion cage combined with unilateral translaminar facet screw fixation using different caliber large channels were selected.The operation time,intraoperative bleeding volume,caliber of the large channels used were recorded.The lumbar CT and lumbar dynamic X-ray films were reexamined after the operation.The diameters of bone windows of all patients were counted and the fixation conditions were observed before and 1 after the operation.Weeks and 1 month follow-up after surgery,pain and function scores were analyzed using VAS and ODI scales for lumbar and leg pain;surgical complications and infections were recorded to analyze the safety of the operation;3 patients who underwent lumbar fusion with double fusion cages combined with bilateral laminar and articular process screw fixation under the large channel from June 2019 to December 2019 were selected to evaluate the efficacy of the above methods.Price,and preliminary summary of double fusion nail placement method.Result1.All 30 cases completed the operation successfully,all of them were fixed by single-segment single-fusion cage under large channel combined with unilateral translaminar facet screw.No complications and infections such as iatrogenic nerve root injury occurred after the operation.2.Operation conditions: distribution of fusion segments: 3 cases of lumbar 3-4(10%),6 cases of lumbar 5-sacral 1(20%),21 cases of lumbar 4-5(70%);operation time(min): 110.3(+20.6),intraoperative blood loss(ml)): 105.3(+5.6),bone window diameter(mm): 15.5(+1.1),fluoroscopy times(times): 28.3(+6.7).Efficacy evaluation: The three scores of low back pain VAS,leg pain VAS and ODI before operation,1 week after operation and 1 month after operation were tested,P > 0.05,which all accorded with normality.The scores of low back pain VAS,leg pain VAS and ODI before operation and 1 week after operation were tested by paired sample T,P < 0.05,which had statistical significance;the scores of low back pain VAS,leg pain VAS and ODI after operation were evaluated by 1 week and 1 month after operation,P < 0.05,which had statistical significance.Significance: It shows that the degree of pain is significantly reduced,the function of waist and leg is also greatly relieved,and the short-term follow-up after surgery is well maintained,and the function of waist and leg is well restored.3.The VAS and ODI scores of three patients with double fusion cages combined with bilateral translaminar facet screw fixation were improved after operation,and there were no related complications.The fusion cage and screw fixation were firmly reviewed after operation.Conclusion1.It is feasible and safe to complete bone window shaping and intervertebral fusion with large passage during Endo-TLIF operation,which can further optimize the operation process and save operation time.2.The treatment of degenerative lumbar instability by single fusion cage combined with unilateral translaminar facet screw fixation under a large channel has achieved good results.3.The internal fixation method of double fusion cages combined with bilateral translaminar facet screw can achieve better support and fixation,and provide new clinical ideas and reference for the clinical treatment of lumbar instability. |
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