胸腰段椎间盘突出症后外侧入路与前外侧入路手术疗效的比较

Surgical outcomes of posterolateral and anterolateral approaches to thoracolumbar intervertebral disc herniation

目的对比两种不同手术入路治疗胸腰段椎间盘突出症的临床疗效。方法回顾性分析我院2000年1月-2010年12月共计48例胸腰段间盘突出症(T10-L2)手术病例,其中采用后外侧经椎间孔入路椎间盘切除椎间融合术治疗33例,采用前外侧经腹膜后入路椎间盘切除椎间融合术治疗15例,记录手术时间、出血量、术后并发症,采用Oswestrey评分问卷调查表评价术前、术后3个月、术后12个月主观功能。结果随访6-24个月,平均随访15.2个月,两组间手术时间、出血量、术后12个月ODI评分比较无统计学差异(P>0.05);ODI评分术后3个月、术后12个月与术前相比有统计学差异(P<0.05);后外侧经椎间孔组并发症少于前外侧经腹膜后组;术后12个月随访两组椎体间融合率96%。结论后外侧经椎间孔入路椎间盘切除椎间融合术与前外侧经腹膜后入路椎间盘切除椎间融合术均是治疗胸腰段椎间盘突出症的有效术式,后外侧经椎间孔入路并发症少。

Objective To compare the clinical outcomes of posterolateral and anterolateral approaches to thoracolumbar intervertebral disc herniation. Methods Forty-eight patients with thoracolumbar intervertebral disc protrusion（T10-L2） admitted to our hospital from January 2000 to December 2010 were retrospectively analyzed in this study. Of these patients, 33 underwent intervertebral resection and fusion through posterolateral transforminal approach, 15 underwent intervertebral resection and fusion through anterolateral retroperitoneal approach. Their operation time, blood loss, and postoperative complications were recorded, and their subjective outcomes were assessed according to the oswestry disability index（ODI） scores before operation, and 3 and 12 months after operation. Results The patients were followed up for 6-24 months（mean 15.2 months）. No significant difference was found in the operation time, blood loss and ODI scores between the two groups 12 months after operation（P〉0.05）. The ODI scores were significantly lower 3 and 12 months after operation than before operation（P〈0.05）. The complications of posterolateral approach were less than those of anterolateral approach. The intervertebral fusion rate was 96% in two groups 12 months after operation. Conclusion Both posterolateral and anterolateral approaches are the effective surgical procedures for thoracolumbar intervertebral disc herniation. However, the complications of posterolateral transforminal approach are less than those of anterolateral retroperitoneal approach.