前后路减压植骨融合内固定术治疗高位腰椎间盘突出症的比较研究  

Comparative study of posterior or anterior lumbar interbody fusion operation for superior position intervertebral disc herniation

作　　者：曹俊明[1] 申勇[1] 杨大龙[1] 孟宪中[1] 王林峰[1] 李志远[1] 杨柳[1] 

机构地区：[1]河北医科大学第三医院脊柱外科,石家庄050051

出　　处：《中国矫形外科杂志》2008年第13期973-975,共3页Orthopedic Journal of China

摘　　要：[目的]评价比较前后路减压植骨融合内固定术治疗高位腰椎间盘突出症的手术疗效。[方法]47例患者(男29例,女18例)平均年龄53.3岁,平均随访(53.5±5)个月。25例行双侧小关节切除自体小关节骨质及Cage后路椎间植骨椎弓根钉内固定术(后路组),22例行前路椎间盘切除植骨融合钛板内固定术(前路组)。比较两组患者的临床治疗基本情况,采用临床功能评估标准进行临床疗效评估,并评价两组患者术前及术后随访时放射学结果及手术并发症。[结果]在手术时间及术中出血量上经后方椎板切除入路优于前外侧入路,在临床症状改善率以及神经损伤发生率上两种手术方式没有显著差异性。后路组术中3例硬脊膜撕裂,1例椎弓根位置偏斜,随访时骨性融合率96.00%。前路组术中2例硬脊膜破裂,3例术后单侧神经根麻痹,1例术后出现难以控制性呃逆,随访时骨性融合率95.45%。[结论]高位腰椎间盘突出症手术治疗是必要的,经后方椎板切除入路可以缩短手术时间,减少术中出血量,是治疗高位腰椎间盘突出症的理想方法。[ Objective ] To evaluate the curative effects of the posterior or anterior lumbar interbody fusion for the treatment of superior position intervertebral disc herniation. [ Method] Forty - seven patients with superior position intervertebral disc herniation were followed up. There were 29 males and 18 females with mean age of 53. 3 years （from 35 to 67 years） . Twewty - five patients were treated with posterior lumbar interbody fusion （PLIF） using facet joint autograft and cage additional of pedicle screw internal fixation （posterior way group）, and 22 patients were treated with anterior disckectomy, bone graft and plates internal fixation （ anterior way group） . The mean follow - up time was 53.5 ± 5 months （from 24 to 78 months） . The clinical resuits were compared between two groups. Clinical functional assessment standard was used to evaluate the clinical curative effect. The changes of the therapeutic effects, the radiographic findings and complications were evaluated. [ Result ] In regard to the operation time and bleeding, the posterior way group was superior to anterior way group. There was no difference between the two groups in clinical recovery rates and nerve root injury rates. Complications included dural tear （ n = 3 ）, and pedicle screw deviating （ n = 1 ） in the posterior way group ; and dural tear （ n = 2）, unilateral transient lower extremity paresthesia （ n =3）, and hard controlled singultation （ n = 1 ） in the anterior way group. The rates of bone fusion were 96.00% and 95.45% in the posterior and anterior way groups. [ Conclusion ] Operation for the superior position intervertebral disc herniation is effective. The posterior lumbar interbody fusion using facet joint autograft and cage additional of pedicle screw internal fixation to shorten the operation time and decrease bleeding is recommend for the treatment of superior position intervertebral disc herniation.

关 键 词：腰椎间盘突出症 高位 融合术 手术疗效 

分 类 号：R687.3[医药卫生—骨科学]