[摘 要] 目的 介绍L-TLIF技术及探讨其治疗腰椎椎体滑脱症的临床价值。 方法 L-TLIF是在TLIF基础上做了改进，放置8-11mm植骨块在脊柱中柱，应用杠杆原理，植骨块作为支点，椎弓根钉棒系统作为力臂，通过适当的压力恢复腰椎前突并维持椎间隙高度。2004年5月～2006年4月采用L-TLIF技术治疗腰椎椎体滑脱症32例，男18例，女24例；年龄42-65岁,平均53.6岁。术前临床症状和手术效果分别按照JOA腰背痛评分标准和JOA改善率进行评估。术前、术后腰椎摄片以判断椎体滑移距离、腰椎前突弧度、椎间隙高度和骨融合情况。结果32例患者经2～18月 (平均12.4月)随访，术后腰椎X线摄片显示腰椎前突弧度、椎间隙高度基本恢复，腰椎滑脱基本复位。术前椎体滑移距离2.5～12.0mm平均6.5±1.3mm，腰椎前突弧度为10.5-32.5度，平均22.5±5.6度，椎间隙高度为3.5～8.5mm,平均6.7cm±0.6mm，JOA评分为(14.8±2.2)分。术后椎体滑移距离为0～3.5mm， 平均1.5±0.8mm，较术前减少76.9%，随访其间腰椎滑移距离无明显变化，腰椎前突弧度为25.5-46.0度，平均32.5±8.3度，椎间隙高度为7.5～11.0mm,平均8.9±0.8 mm，JOA评分为(26.8±2.8)分，术后JOA改善率为74.5%，随访大于12个月的24个病例均见明确的椎间骨融合现象。结论 使用L-TLIF技术治疗腰椎椎体滑脱症取得了较好的近期临床效果，腰椎滑脱基本复位，并有效地恢复了腰椎前突和椎间隙高度，获得了较高的骨融合率，为治疗腰椎椎体滑脱症提供了一个可供选择的新方法。

    [关键词]脊椎滑脱；腰椎；脊柱融合术

    A Prospective study of the treatment for lumbar spondylolisthesis with lever transforaminal lumbar interbody fusion (L-TLIF)

    Tu Yihui, Du JingYuan, Cai Mingwei , et al. 1 Department of Orthopedics, Yang Pu Central Hospital, Shanghai 200090. 2 Department of Orthopedics, The union hospital of Tongji medical university, Wuhan 435000

    [Abstract] Objective To assess the clinical and radiographic outcome of L–TLIF and describe the technique in the treatment of lumbar spodylolisthesis Methods This fusion procesure is a refinement of TLIF(lever transforaminal lumbar interbody fusion). L-TLIF placed local autologous graft mass in the middle column followed by local autologous graft granule in the anterior column. Compression across pedicle screw instrument using the graft mass as a fulcrum creates restoration of lodosis and the graft mass is under compression. This study prospectively evaluated 32 consecutive patients. 24 women and 18 men were studied, with a mean age of 53.6 years. The changes in the Japanese Orthopedics Association score, the recovery rate, and radiographic findings were evaluated. Results Clinical outcome and radiographic date are being collected. All of patients were followed for a average period of 12.4 months, Translational distance and lodosis were restored from 10.5-32.5 degree、2.5～12mm ......