经关节突减压植骨内固定术治疗胸腰段椎间盘突出症疗效观察

Observation of the effect of transfacet approach decompression and fixation on thoracolumbar disk herniation

目的：观察后路经关节突减压植骨融合固定术治疗胸腰段椎间盘突症的临床疗效。方法对16例胸腰段椎间盘突出症患者进行后路经关节突切除减压植骨融合内固定术治疗，采用日本骨科协会（ JOA）评分法及Otani评分系统评定手术疗效。结果所有手术均顺利完成，平均手术时间175．2 min；术中平均出血量630．5 mL；术中3例患者因硬膜撕裂发生脑脊液漏，给予缝合及修补后愈合。 JOA评分由术前的（6．3±2．0）分，恢复为术后3个月的（9．2±2．8）分以及末次随访时的（9．6±3．1）分，神经功能改善率达70％；术后随访15～32个月，随访期间无内固定物松动、移位及脊柱不稳发生；末次随访时根据Otanni评分获优8例，良4例，可3例，差1例，优良率为75％。结论后路经关节突减压植骨内固定术作为治疗胸腰段椎间盘突出症的一种有效术式，在脊髓获得充分减压的同时能有效维持脊柱的稳定性。

Objective It is to observe the therapeutic effects of transfacet approach decompression and fixation on thoraco -lumbar disk herniation .Methods 16 patients with thoracolumbar disk herniation accepted the transfacet approach decompres -sion and fixation .The postoperative curative effect was measured by JOA score and Otani scoring system .Results All the op-erations were completed successfully , the average operative time was 175.2 min, and the mean blood loss was 630.5 ml. Three patients appeared intranperative cerebrospinal fluid leakage , and recovered after treatment .Compared with the preopera-tive level which was 6.3 ±2.0, the JOA scores had a significant recovery at 3 months which was 9.2 ±2.8 and at the last fol-low-up which was 9.6 ±3.1 （P〈0.05）.The improvement rate of nerve function was 70%.After 15-32 month＆#39;s following up, there was no complication such as fixation looseness , movement and spinal instability .Based on Otani score of the last fol-low-up, there was 8 excellent patients,4 good ones, 3 fair ones and one poor case, and the good rate was 75.0%.Conclu-sion As one of the effective procedure , transfacet approach decompression and fixation could provide an adequate decompres -sion and maintain the spinal stability efficiently .