胸椎间盘突出症后外侧入路与后正中入路手术的并发症分析  

Complications occurring in the treatment of thoracic disc herniation using posterolateral and posterior entrances

作　　者：李宝俊[1] 孙亚澎[1] 丁文元[1] 申勇[1] 赵金彩[1] 张为[1] 杨大龙[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》2009年第3期172-176,共5页Orthopedic Journal of China

基　　金：河北省科技攻关项目资助(编号:0327619D-23)

摘　　要：[目的]总结经后外侧入路手术治疗胸椎间盘突出症的疗效及并发症并与后正中入路进行比较。[方法]回顾分析本院1998年11月～2007年2月间收治的77例胸椎间盘突出症患者的临床资料,其中采用经一侧关节突切除后外侧入路手术治疗51例(A组),采用后正中入路椎板切除减压术治疗26例(B组)。采用Otanni评分系统进行疗效评估,并计算临床优良率;观察两组治疗效果及并发症情况,计算神经功能改善率;应用SPSS13.0软件对数据进行统计学处理。[结果]手术时间A组130～185min,平均162min,B组145～205min,平均168min,两组间无显著性差异(P=0.062)。出血量A组400～600ml,平均485ml,B组500～800ml,平均646ml,两组间有显著性差异(P=0.013)。A组临床疗效评定优26例,良18例,可6例,差1例,临床优良率为86.3%;B组优10例,良8例,可6例,差2例,临床优良率69.2%,两组间有显著性差异(P=0.025)。A组中术后神经功能改善不明显2例,脊髓反应性水肿1例,内固定松动取出2例,脊髓前动脉综合征1例,脑脊液漏1例,神经功能改善率为90.2%。B组中术后神经功能改善不明显6例,脊髓反应性水肿1例,脑脊液漏2例,脊髓前动脉综合征1例,内固定松动取出1例,神经功能改善率为61.5%,两组相比有统计学差异(P=0.034)。[结论]经一侧关节突切除后外侧入路较后正中入路手术治疗胸椎间盘突出症的临床效果良好、神经功能恢复率高、手术安全性高。[ Objective ] To analyze and compare the results of the posterolateral entrance and posterior laininectomy in treating thoracic disc herniation. [Method] From Nov. 1998 to Feb. 2006, fifty -one cases were treated with posterolateral entrance combined with the facet disectomy （Group A） , and 26 patients were treated with the vertebral disectomy instead of the thoracic disc tissue disectomy. Complications occurring in the follow -up time were investigated and the improving rates were calculated. Otanni Systems was used to evaluate the clinical results. The SPSS 13.0 was used for statistic work. [ Result] The operation time was 130 - 185 min （mean 162 min） for Group A, 145 -205 min （mean 168 min） for Group B. No difference existed （P = 0. 062） . The blood lost was 400 - 600 ml （ mean 485 ml ）, while in group B, it was 500 - 800 ml （ mean 646 ml） , tbere was significant difference （P = 0. 013 ） . The clinical satisfaction rate of group A was 86. 3 % , 26 patients returned to perfect results, with 18 in good, 6 in fair and 1 in poor results. In group B, the clnical satisfaction rate was 69. 2%. There was significant difference between 2 groups （P = 0. 025 ） . Seven out of the 51 patients had complications in group A. Two patients of neurological dysfunction showed no improvement. One patient was found having spinal cord reactive edema. Internal fixation system was removed in 2 patients because of loosening and paresthesia. Anterior spinal artery syndrome was found in 1 patient. Leakage of CSF was observed in 1 patient. While in the Group B , six patients neurological dysfunction showed no improvement. One patient was found having spinal cord reactive edema. Internal fixation system was removed in 1 patient. Anterior spinal artery syndrome was found in 1 patient. Leakage of CSF was observed in 2 patients. There were obvious difference （P = 0. 034） . [ Conclusion ] Posterolateral entrance is effective in treating thoracic disc herniation. Comparing with the posterior lam-inectomy , th

关 键 词：手术治疗 胸椎 椎间盘 并发症 后外侧入路 

分 类 号：R687.3[医药卫生—骨科学]