经后外侧入路椎间盘摘除椎间融合术治疗胸椎间盘突出症

Posterolateral approach for thoracic disc herniation

中文关键词:  胸椎间盘突出症  经后外侧入路  手术治疗  疗效评价

英文关键词:Thoracic disc herniation  Posterolateral entrance  Operative treatment  Efficacy

中文摘要:

  【摘要】 目的：评价经后外侧入路椎间盘摘除椎间融合术治疗胸椎间盘突出症的安全性和有效性。方法：2006年1月~2012年8月采用经后外侧入路椎间盘摘除椎间融合术治疗胸椎间盘突出症（TDH）患者24例，男15例，女9例，年龄37~64岁，平均45.3岁。病程4个月~2年，平均14个月。均为单节段椎间盘突出，中央型突出16例，旁中央型8例；突出为硬性18例，软性6例。突出部位：T7/8 2例，T8/9 4例，T9/10 4例，T10/11 5例，T11/12 9例。其中3例合并胸椎黄韧带骨化，4例合并胸椎后纵韧带骨化。手术前后进行JOA评分和Otani分级，并通过Bridwell标准评价骨融合情况。结果：患者均顺利完成手术，未出现神经损伤。1例切口脂肪液化延迟愈合，其余均Ⅰ期愈合。3例术中硬脊膜损伤，术中修补后2例术后未发生脑脊漏，1例发生脑脊液漏，经置管引流后治愈。24例均获随访，随访时间0.5~3.5年，平均2.1年。术后定期门诊复查。患者症状均得到不同程度改善，随访期间未见神经症状加重及脊柱不稳等情况。术前改良JOA评分为4.4±2.4分，术后3个月为8.7±2.3分，末次随访时为9.0±2.3分，术后3个月和末次随访时与术前比较差异均有统计学意义（P＜0.05）。末次随访时临床改善率为（74.6±16.6）%。根据Otani分级，优9例，良11例，可2例，差2例，优良率为83.3%。2例截瘫患者中，1例无明显恢复，1例术后半年由Frankel A级恢复至C级。术后3个月随访植骨块均达到Ⅱ级或Ⅲ级愈合，术后6个月时Ⅰ级愈合6例，其余均达Ⅱ级愈合，19例随访9个月以上的患者9个月时均达到Ⅰ级愈合。随访期内无内固定松动、断裂和节段间塌陷等。结论：采用经后外侧入路椎间盘摘除椎间融合术治疗胸椎间盘突出症可获得较好的临床效果。

英文摘要:

  【Abstract】 Objectives: To evaluate the surgical outcome of posterolateral approach for treatment of thoracic disc herniation. Methods: 24 patients with thoracic disc herniation(TDH) were treated surgically from January 2006 to August 2012. There were 15 males and 9 females, with the age arranging from 37 to 64 years, (average, 45.3 years), duration of onset was from 4 months to 2 years, with an average of 14 months. All patients had single level involved which presented with central herniation in 16 cases and paracentral in 8 cases, hard disc was noted in 18 cases, soft disc in 6 cases. The lesion was T7/8 in 2 cases, T8/9 in 4 cases, T9/10 in 4 cases, T10/11 in 5 cases and T11/2 in 9 cases. Of them, 3 cases were associated with ossification of thoracic ligament flavum, 4 cases with ossification of posterior longitudinal ligament. Pre and postoperative JOA score and Otani grading were recorded. The fusion status was evaluated by Bridwell. Results: All surgeries were successfully performed, and no neurological deficit was noted. All patients had good skin healing except for skin problem in 1 case. 1 of 3 cases with CSF leakage due to dural tearing was cured by subarachnoid drainage. 24 cases were followed up for 0.5 to 3.5 years with an average of 2.1 years. The clinical symptoms relieved significantly, with no neurological deterioration and instability noted during follow-up. The preoperative JOA score was 4.4±2.4 points, the postoperative JOA score was 8.7±2.3 points at 3 months, 9.0±2.3 points at the last follow-up, which showed significant differences(P<0.05), the clinical improvement rate was(74.6±16.6)%. According to Otani grading, excellent was noted in 9 cases, good in 11 cases, fair and poor in 2 cases, respectively, with an excellent and good rate of 83.3%. One of two cases suffering paraplegia showed no obvious improvement, while the other improved from Frankel A to C at 6 months after operation. No instrument failure was observed. According to Bridwell criteria, all cases got grade Ⅱ or Ⅲ at postoperative 3 months; 6 cases got grade Ⅰ, the other cases got grade Ⅱ at postoperative 6 months; all cases got grade Ⅰ at postoperative 9 months. Conclusions: The posterolateral approach is effective for thoracic disc herniation.