经后外侧入路减压椎弓根钉内固定治疗胸腰段椎间盘突出症

Treatment of thoracolumbar disc herniation by decompression combined with internal fixation of pedicle screw through posterolateral approach

目的探讨采用经后外侧入路减压椎弓根钉内固定术治疗胸腰段椎间盘突出症的疗效和注意事项。方法自2005年1月-2010年1月收治胸腰段椎间盘突出症13例，发病节段：T11、12 4例，T12 L1 5例，L1、2 4例。椎间盘突出类型：中央型2例，旁中央型4例，侧后方突出7例。症状：胸腰背痛13例，下肢无力9例，大小便障碍7例，性功能障碍3例，足下垂4例。所有患者均常规行X线、CT、MRI全脊柱扫描，确定责任节段后经后外侧入路行减压内固定术。通过JOA评分、并发症发生情况评估疗效。结果术后13例获得随访32．6（13～52）个月。根据JOA评分：优9例，良3例，可1例，优良率92．3％。无内固定断裂或松动现象、无胸腰椎后凸加重现象。结论经后外侧入路可以安全有效对胸腰椎间盘突出进行减压。内固定使减压后病变节段融合及维持生理曲度，是治疗胸腰段椎间盘突出症的有效手段。

Objective To evaluate the effect of decompression combined with internal fixation of pedicle screw in the treatment of thoraeolumbar disc herniation through posterolateral approach. Methods From Jan. 2005 to Jan. 2010, 13 eases of thoraeolumbar disc herniation were treated in our hospital. The course of disease was 13.6 months （from 4 to 26 months）. Among them, 4 cases involved T11、12 5 eases T12 L1, 4 cases L1,2. Thirteen cases presented with lumbodorsal pain, 9 eases lower limbs weakness, 7 eases spineter muscle disturbance, 3 cases sexual dysfunction, 4 eases foot drop. The responsible lesion segments were analyzed by clinical presentation associated with X-ray, MRI and CT. All cases were treated by decompression with internal fixation of pediele screw through posterolateral approach and retrospectively analyzed according to Japanese Orthopaedic Association （JOA） Scoring System. Results The mean follow-up period was 32.6 months （ranging from13 to 52 months）. According to the JOA scoring system, excellent in 9 eases, good in 3 eases, fair in 1 ease, the excellent and good rate was 92.3%. And no breakage and loosening of titanium screws and postoperative thoraeolumbar kyphosis Occur. Conclusion Decompression with internal fixation of pedicle screw through posterelateral approach is a safe and effective method for treatment of thoracolumbar disc herniation.