经后外侧入路椎管减压椎间融合内固定术治疗胸椎间盘突出症

发布时间：2018-03-24 09:19

本文选题：胸椎间盘突出症　切入点：椎管减压　出处：《中国脊柱脊髓杂志》2016年10期

【摘要】：目的:观察经后外侧入路椎管减压椎间融合内固定术治疗胸椎间盘突出症的手术疗效。方法:选择2009年1月~2015年8月收治的47例单节段胸椎间盘突出症患者,采用椎管减压椎间融合内固定术治疗,其中经后外侧入路组26例,经侧前方入路组21例。术前两组患者的年龄、性别分布、病程、病变节段、突出类型、脊髓受压情况、临床表现、随访时间均无统计学差异(P0.05)。记录两种术式的手术时间、术中出血量和手术并发症;术前及术后3d、6个月采用疼痛视觉模拟评分(VAS)评估疼痛情况;术后6个月采用Otani分级评定其临床疗效,采用改良胸脊髓神经功能JOA评分及神经功能Frankel分级评估神经功能恢复情况,影像学测算椎管矢状径残余率评估椎管减压程度,CT薄层扫描重建评估椎间融合情况,动态X线片对固定情况进行评估。结果:经后外侧入路组的手术时间、术中出血量、切口长度和住院时间均优于经侧前方入路组,差异有统计学意义(P0.05)。经侧前方入路组术后发生胸腔积液4例、肺炎4例、脑脊液漏2例、肠麻痹5例,经后外侧入路组术后无上述并发症出现,两组并发症发生率的差异有统计学意义(P0.05)。术后6个月两组Otani分级优良率无统计学差异(P0.05)。术后3d经后外侧入路组VAS评分优于经侧前方入路组,差异有统计学意义(P0.05)。术后6个月两组患者的疼痛、神经功能及椎管有效容积均较术前明显改善,差异有统计学意义(P0.05)。术后6个月,两组间VAS评分、JOA评分、神经功能Frankel分级和椎管矢状径残余率比较均无统计学差异(P0.05),CT三维重建显示两组椎间融合率均为100%,差异无统计学意义(P0.05);动态X线片检查脊柱连续性及稳定性良好,无钉棒断裂和松动现象,椎间高度无明显丢失,椎体间cage无下陷及移位。结论:后外侧入路椎管减压椎间融合内固定术治疗胸椎间盘突出症的近期效果满意。
[Abstract]:Objective: To observe the curative effect of posterior lateral decompression and interbody fusion and internal fixation for the treatment of thoracic disc herniation. Methods: January 2009 ~2015 year in August 47 cases of single segmental thoracic disc herniation, spinal canal decompression and interbody fusion and internal fixation, the posterior lateral group 26 cases of anterolateral group 21 cases. The two groups of patients with age, preoperative gender distribution, duration, prominent lesion segment type, spinal cord compression, clinical manifestation, follow-up time were not statistically significant (P0.05). The record of two kinds of surgical operation time, intraoperative blood loss and surgical complications.; preoperative and postoperative 3D, 6 months with visual analogue scale (VAS) assessment of pain; 6 months after surgery using Otani classification to assess its clinical curative effect, using modified thoracic spinal cord nerve function JOA score of nerve function and Frankel neural functional recovery evaluation. The imaging conditions, measurement of sagittal diameter of spinal canal decompression rate of residual evaluation, CT scan reconstruction assessment of interbody fusion, dynamic radiographic assessment of fixation. Results: the operative time through posterolateral approach group, intraoperative blood loss, incision length and length of time were better than the anterolateral group, the difference was statistically significant (P0.05). Anterolateral group postoperative pleural effusion in 4 cases, 4 cases of pneumonia, 2 cases of cerebrospinal fluid leakage, 5 cases of intestinal paralysis, through posterolateral approach group after surgery without the complications, incidence of complications in the two groups the difference was statistically significant (P0.05) at 6 months after surgery, two groups of Otani grade excellent rate showed no significant difference (P0.05). 3D after operation through posterolateral approach group VAS score than the anterolateral group, the difference was statistically significant (P0.05). Pain for 6 months of the two groups of patients after operation, neurological function and spinal canal volume were effective compared with Improved significantly, the difference was statistically significant (P0.05). 6 months after surgery, two groups of VAS score, JOA score, Frankel classification of nerve function and sagittal diameter of spinal canal residual rate were no statistically significant difference (P0.05), CT three-dimensional reconstruction showed that the two groups of intervertebral fusion rate was 100%, the difference was statistically the significance (P0.05); dynamic X-ray spinal continuity and stability, no screw breakage and loosening of the phenomenon, no obvious loss of intervertebral height, intervertebral cage without sagging and shift. Conclusion: the recent effect of posterolateral decompression and interbody fusion and internal fixation for the treatment of thoracic disc herniation.

【作者单位】：宁夏医科大学总医院脊柱骨科;宁夏医科大学研究生院;美国南佛罗里达大学药学院;
【分类号】：R687.3

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