两种手术方式治疗高位腰椎间盘突出症的临床疗效

Clinical effects of two modes of surgery in treatment of upper lumbar disc intervertebral herniation

目的比较两种后路减压植骨融合内固定方式治疗高位腰椎间盘突出症的疗效。方法 38例高位腰椎间盘突出分为横突间融合组和椎间融合组,患者行后路减压内固定,23例行横突间融合,15例行椎间融合,比较各组手术前后JOA评分,分别比较两组手术时间、出血量及术后优良率,观察临床并发症。结果横突间融合组平均手术时间为(122.3±13.61)min,出血量为(232.45±26.35)m L,治疗前JOA为(11.08±2.56),治疗后JOA评分为(25.72±2.96),差异有统计学意义(P<0.05);术后优良率86.96%;椎间融合组平均手术时间为(155.68±20.36)min,出血量为(318.67±32.91)m L,治疗前JOA为(10.56±3.18),治疗后JOA评分为(24.36±3.45),手术后JOA评分较术前增加,差异有统计学意义(P<0.05),术后优良率86.67%。横突间融合组较椎间融合组手术时间及出血量少(P<0.05),但两组术后JOA评分及优良率无明显差异;均无严重术后并发症。结论经后路减压内固定横突间融合治疗高位腰椎间盘突出更安全。

Objective To compare two surgical modes of posterior decompression bone grafting fusion with internal fixation in treatment of upper lumbar disc intervertebral herniation. Methods A total of 38 patients with upper lumbar disc intervertebral herniation were divided into the intertransverse fusion group and the interbody fusion group. 23 patients were treated by intertransverse fusion while 15 were treated by interbody fusion after posterior decompression and internal fixation. The JOA scores before and after operation were compared between the two groups, as well as the duration of operation, blood loss in operation, and excellent and good rates after operation. The clinical complications were also observed. Results In the intertransverse fusion group, the average operation time was（122.3±13.61） min, the blood loss during operation was（232.45±26.35）m L, the JOA scores before treatment were（11.08±2.56）, while after treatment were（25.72±2.96）, which were significantly different（P〈0.05）, the excellent and good rate after operation was 86.96%.In the interbody fusion group, the average operation time was（155.68±20.36） min, the blood loss during operation was（318.67±32.91）ml, the JOA scores before treatment were（10.56±3.18）, while after treatment were（24.36±3.45）, which were significantly higher than those before treatment（P〈0.05）, the excellent and good rate after operation was 86.67%.The blood loss during operation was significantly lower in the intertransverse fusion group than that in the interbody fusion group（P〈0.05）, but there was no significant difference in the JOA scores after treatment and the excellent and good rates between two groups. No severe postoperative complication was observed. Conclusion Intertransverse fusion after after posterior decompression and internal fixation shows higher safety in treatment of upper lumbar disc intervertebral herniation.