微创可扩张通道辅助经横突间入路手术治疗极外侧腰椎间盘突出症  

Discectomy of far lateral lumbar disc heniation by intertransverse approach with minimally invasive channel

作　　者：夏刚[1] 田融[1] 李会明[1] 刘洋[1] 

机构地区：[1]天津市人民医院脊柱外科,天津300121

出　　处：《中国矫形外科杂志》2013年第13期1307-1312,共6页Orthopedic Journal of China

摘　　要：[目的]评价微创可扩张通道辅助下经横突间入路手术治疗极外侧腰椎间盘突出症的临床效果及手术技巧。[方法]2008年1月～2010年12月,42例极外侧型椎间盘突出症患者,男18例,女24例;平均年龄57.4岁。其中椎间孔内突出型24例,椎间孔外突出型18例。均采用经横突间入路微创可扩张通道辅助下的椎间盘切除手术治疗。手术前后行下肢疼痛VAS评分,术后采用改良MacNad标准进行临床疗效评定。[结果]平均手术时间86 min,平均失血82 ml,与同时期相同入路但未使用微创通道的12例患者相比,两项指标均明显减少(P<0.05)。42例患者平均随访时间28个月。VAS评分术前平均为7.6,术后2周平均为2.3,术后半年为1.3。术后半年MacNad评定结果:优26例、良10例、可6例;优良率85.7%。椎间孔内型组和椎间孔外型组术后优良率分别为83.3%和88.9%。两组间优良率差异无统计学意义(P>0.05)。术后并发症为1例术后伤口血肿。[结论]应用微创可扩张通道辅助下经横突间入路手术治疗极外侧腰椎间盘突出症创伤小、安全性好,近期效果良好,可以作为极外侧型腰椎间盘突出症微创手术方式的选择之一。[ Objective] To evaluate the clinical results and surgical techniques of discectomy in the treatment of far lateral lumbar disc herniation by intertransverse approach with minimally invasive channel. [ Methods ] The study group included 42 patients （ 18 male and 24 female） with far later~ lumbar disc herniation treated from January 2008 to December 2010. The mean age of the patients was 57. 4 years. There were 24 cases of inforaminal disc herniation and 18 cases of extraforaminal disc hernia- tion . In our procedure, they were all treated with intertransverse approach assisted by minimally invasive channel. The VAS （visual analogue scale） of radicular leg pain was taken before and after operation. The postoperative outcomes were determined using the modified MaeNad criterion. [ Restdts] Mean operative time of all operation was 86 minutes and mean bleeding volume was 82 ml, they were significantly reduced compared with the patients （12 cases） who were performed by same approach without minimally invasive channel. All the patients were followed up for an average period of 28 months. The mean VAS scores of radic- ular pain was 7.6 preoperatively, 2.3 at 2 weeks ＂after the operation and I. 3 at 6 months after the operation. The clinical out- comes at 6 months after the operation by modified MaeNad criterion were as follow： excellent l^sults in 26 cases, good in 10 and fair in 6 cases , with overall excellent and good results rate of 85.7%. The postoperative overall excellent and good results rate for infi）raminal disc herniation and extraforaminal diac heniation were 83.3% and 88.9% respectively with no statistically signifi- cant difference between the two groups （P 〉 0. 05 ） . The postoperative complication included wound hematoma in 1 case. [ Conclusion ~ Discectomy by intertransverse approach with minimally invasive channel is safe in the treatment of far lateral lum- bar disc herniation . The operation ＇allows less tissue trauma and achieve satisfying clinical results. It could be a min

关 键 词：极外侧型椎间盘突出症 椎间盘切除术 横突间入路 微创通道 

分 类 号：R687.3[医药卫生—骨科学]