双侧椎间孔入路治疗胸腰段巨大中央型椎间盘突出症

Bilateral Transformational Thoracolumbar Interbody Fusion for the Treatment of Giant Central Thoracolumbar Junction Disc Herniation

目的探讨应用双侧椎间孔入路间盘切除减压椎间融合治疗胸腰段巨大椎间盘突出并神经损伤的临床疗效及安全性。方法对2014年1月至2015年6月我院收治的20例经双侧椎间孔入路间盘切除减压椎间融合治疗胸腰段巨大椎间盘突出并神经损伤的患者进行前瞻性研究,资料包括手术时间、术中失血、手术前后神经功能ASIA运动及感觉评分、VAS及ODI评分、融合率、减压范围、内固定失败及并发症发生率。结果平均手术时间(155±27)min,术中失血(824±162)mL,ASIA运动及感觉评分分别从术前的(72.88±3.26)分、(67.52±4.2)分提高到术后末次随访时的(90.34±2.74)分、(88.3±3.1)分,VAS和ODI评分分别从术前的(6.78±1.99)分、(44.82±5.18)%降低到末次随访时的(2.34±0.46)分和(11.7±2.4)%,椎管容积从术前的(51.3±5.6)%增高到(2±0.5)%,椎间植骨融合率均100%,术中5例患者出现硬脊膜破裂脑脊液漏,未出现神经症状加重、感染等并发症。结论经双侧椎间孔入路间盘切除减压椎间植骨融合安全有效,可以作为治疗胸腰段连续椎间盘巨大突出并神经损伤的手术选择。

Objective To explore the efficacy and safety of bilateral transforaminal thoracolumbar interbody fusion （bilateral TTIF） to treat giant central TLDH.Methods Twenty consecutive patients with giant central TLDH underwent bilateral TTIF from January 2014 to June 2015 and were followed for 12 months.Clinical and radiological data were prospectively examined,including operative time,blood loss,pre-and postoperative American Spinal Injury Association （ASIA） score for sensory and motor function,visual analogue scale （VAS） and Oswestry Disability Index （ODI） scores,fusion rate,extent of decompression,rate of instrumentation failure,and complications.Results The average time of surgery was （155±27）min,and blood loss was （824±162）mL.The ASIA sensory and motor scores improved from （72.88±3.26） to （90.34±2.74） and from （67.52±4.2）to （88.3±3.1）,respectively.VAS for back pain and ODI decreased from （6.78±1.99） to （2.34±0.46） and from （44.82±5.18）% to （11.7±2.4）%,respectively.Canal encroachment improved from （51.3±5.6）% to （2±0.5）% at the last follow-up.Surgery complications were seen in 5 patients （25%）,who experienced intraoperative dural tear and cerebrospinal fluid leak.There were no other major complications at last follow-up.Conclusion Bilateral TTIF produced satisfactory outcomes and may be one of the surgical treatments of choice for myelopathy due to giant central TLDH.