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經(jīng)椎間孔腰椎椎體間融合術(shù)（TLIF）用于切除引起腰腿痛的一部分椎間盤。與后路腰椎椎間融合術(shù)（PLIF）一樣，在椎間盤去除后，用骨移植融合脊椎骨。然而，TLIF手術(shù)通過側(cè)方在椎體間放置單個植骨塊，而不象PLIF手術(shù)從后方放置兩個植骨塊。去除關(guān)節(jié)突關(guān)節(jié)從側(cè)面植骨是為了盡量避免術(shù)中移動或損傷神經(jīng)根。 警告：請在有WIFI的場所觀看視頻，土豪請隨意。 Introduction （介紹） 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. 經(jīng)椎間孔腰椎椎體間融合術(shù)（TLIF）用于切除引起腰腿痛的一部分椎間盤。與后路腰椎椎間融合術(shù)（PLIF）一樣，在椎間盤去除后，用骨移植融合脊椎骨。然而，TLIF手術(shù)通過側(cè)方在椎體間放置單個植骨塊，而不象PLIF手術(shù)從后方放置兩個植骨塊。去除關(guān)節(jié)突關(guān)節(jié)從側(cè)面植骨是為了盡量避免術(shù)中移動或損傷神經(jīng)根。 Decompression （減壓） 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. 在腰后部正中作一個切口，用手術(shù)器械一側(cè)的整個關(guān)節(jié)突關(guān)節(jié)切除，以顯露退變的椎間盤。用抓鉗去除大部分椎間盤，去除關(guān)節(jié)突關(guān)節(jié)和椎間盤解除了脊神經(jīng)的壓迫，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. 從側(cè)方經(jīng)過去除了關(guān)節(jié)突關(guān)節(jié)的區(qū)域?qū)蝹€植骨塊放入椎間隙。骨移植能在上下椎體融合時為脊柱提供穩(wěn)定性。這一步驟方法各異，可以用間隔器、填塞了植骨材料的融合器或?qū)⒀兴榈闹补遣牧先胱甸g隙以幫助融合。 Preparing for Fusion （準備融合） 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. 在橫突上準備附加的融合，進一步穩(wěn)定脊柱。用動力設(shè)備將橫突的外層骨皮質(zhì)去除。這里將為新的融合附加骨移植。 Stabilizing the Spine （穩(wěn)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. 在進行骨移植之前，先植入內(nèi)植物以穩(wěn)定脊柱。用鉆頭在椎體的椎弓根區(qū)鉆孔，接著順著這些孔擰入螺釘。然后，在螺釘之間安裝棒并固定。釘棒內(nèi)植物增加脊柱穩(wěn)定性，防止椎體在植骨融合之前發(fā)生移動。 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. 植骨可來自患者自已的骨碎片（自體植骨），來自骨庫的加工骨（同種異體骨）或骨移植材料（脫鈣骨、多孔陶瓷或骨形態(tài)發(fā)生蛋白）。如果從患者身上取移植骨，往往在骨盆后方作另一個切口。從髂棘上取骨，放置于剛才準備好的部位，此處外層骨皮質(zhì)已去除。最終，骨頭在此生長，將脊柱融合并提供額外的穩(wěn)定性。 Summary （總結(jié)） 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. 關(guān)閉切口并包扎，完成手術(shù)。如果椎板切除植骨融合的同時進行內(nèi)固定，可在術(shù)后即時增加脊柱的穩(wěn)定性，能夠減少術(shù)后支具的使用?；颊咝g(shù)后通常住院2～4天，6-12周內(nèi)需要避免負重、彎腰、扭腰，轉(zhuǎn)身等。 （胡佰文 譯） 精彩視頻魅力無限，收藏轉(zhuǎn)發(fā)一起分享 您的每一次打開，都會有精彩的內(nèi)容 您的每一次留言，都會有滿意的答復 您的每一次點贊，都是對我們的肯定 您的每一次分享，都是對我們的鼓勵 世界多姿多彩 感謝有您相伴 |
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