骨科手术早知道101：经椎间孔腰椎椎体间融合术（TLIF）

　　经椎间孔腰椎椎体间融合术（TLIF）用于切除引起腰腿痛的一部分椎间盘。与后路腰椎椎间融合术（PLIF）一样，在椎间盘去除后，用骨移植融合脊椎骨。然而，TLIF手术通过侧方在椎体间放置单个植骨块，而不象PLIF手术从后方放置两个植骨块。去除关节突关节从侧面植骨是为了尽量避免术中移动或损伤神经根。

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Introduction （介绍）

A transforaminal lumbar interbody fusion (TLIF) is performed to remove a portion of a disc that is the source of back or leg pain. Like the PLIF (posterior lumbar interbody fusion) procedure, bone graft is used to fuse the spinal vertebrae after the disc is removed. However, the TLIF procedure places a single bone graft between the vertebrae from the side, rather than two bone grafts from the rear as in the PLIF procedure. Inserting the graft from the side where the facet joint has been removed is an effort to avoid moving or damaging nerve roots during the procedure.

Decompression （减压）

An incision is made in the middle of the low back. Surgical instruments are used to remove the entire facet joint on one side in order to allow access to the degenerated disc. A grasping instrument is used to remove most of the intervertebral disc. Removing the facet joint and disc relieves pressure on the compressed spinal nerve, allowing it to return to the proper position.

　　在腰后部正中作一个切口，用手术器械一侧的整个关节突关节切除，以显露退变的椎间盘。用抓钳去除大部分椎间盘，去除关节突关节和椎间盘解除了脊神经的压迫，使它能重新回到正常的位置。

Graft Placement （植骨）

A single bone graft is placed in the disc space from the lateral (side) aspect through the area exposed when the facet joint was removed. The bone graft will provide stability to the spine when it fuses with the vertebrae above and below it. In variations of this procedure, spacers, cages packed with graft material, or ground bone graft material may also be packed into the disc space to aid with the fusion.

　　从侧方经过去除了关节突关节的区域将单个植骨块放入椎间隙。骨移植能在上下椎体融合时为脊柱提供稳定性。这一步骤方法各异，可以用间隔器、填塞了植骨材料的融合器或将研碎的植骨材料塞入椎间隙以帮助融合。

Preparing for Fusion （准备融合）

To prepare for additional fusion along the transverse processes, which will further stabilize the vertebrae, a motorized instrument is used to remove the top (cortical) layer of the transverse processes. This is the site where the bone grafts for the new fusion will be added.

　　在横突上准备附加的融合，进一步稳定脊柱。用动力设备将横突的外层骨皮质去除。这里将为新的融合附加骨移植。

Stabilizing the Spine （稳定脊柱）

Before bone grafts are added, instrumentation is introduced to stabilize the spine. A drill is used to make holes in the pedicle area of the vertebrae, and screws are placed in the drilled holes. Next, rods are positioned between the screws and fastened in place. The rod and screw instrumentation provides stability to the spine and prevents the vertebrae from moving while the bone graft fusion takes place.

　　在进行骨移植之前，先植入内植物以稳定脊柱。用钻头在椎体的椎弓根区钻孔，接着顺着这些孔拧入螺钉。然后，在螺钉之间安装棒并固定。钉棒内植物增加脊柱稳定性，防止椎体在植骨融合之前发生移动。

Bone Graft （骨移植）

Bone grafting can be done with pieces of a patient’s own bone (autograft), processed bone from a bone bank (allograft), or a bone graft substitute (demineralized bone, ceramic extender, or bone morphogenetic protein). To harvest a patient’s own bone for grafting, a second incision is made over the back of the pelvis. Bone is removed from the iliac crest and placed along the prepared site where the top layer of bone was removed. This bone eventually grows in place, fusing the spine and providing additional stability.

　　植骨可来自患者自已的骨碎片（自体植骨），来自骨库的加工骨（同种异体骨）或骨移植材料（脱钙骨、多孔陶瓷或骨形态发生蛋白）。如果从患者身上取移植骨，往往在骨盆后方作另一个切口。从髂棘上取骨，放置于刚才准备好的部位，此处外层骨皮质已去除。最终，骨头在此生长，将脊柱融合并提供额外的稳定性。

Summary （总结）

The incisions are closed and dressed to complete the procedure. Adding the instrumentation with bone graft fusion increases the strength of the spine directly after surgery, and may decrease the need for a post-operative brace. Patients often remain in the hospital for two to four days following the procedure and should avoid heavy lifting, bending, twisting, and turning for six to twelve weeks.

　　关闭切口并包扎，完成手术。如果椎板切除植骨融合的同时进行内固定，可在术后即时增加脊柱的稳定性，能够减少术后支具的使用。患者术后通常住院2～4天，6-12周内需要避免负重、弯腰、扭腰，转身等。

（胡佰文译）

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