症状侧可扩张通道下减压植骨融合术治疗影像学不典型的腰椎间盘突出症  

Treatment of lumbar disc herniation with atypical radiographic view by transforaminal lumbar interbody fusion from symptomatic side plus quadrant minimally invasive system

作　　者：尚晖[1] 郭振鹏[1] 王达义[1] 常巍[1] 岑毕文[1] 邓磊[1] 杨棋[1] 

机构地区：[1]湖北省十堰市太和医院(湖北医药学院附属医院)脊柱外科,442000

出　　处：《临床外科杂志》2017年第7期537-539,共3页Journal of Clinical Surgery

摘　　要：目的评价仅症状侧入路通道下减压并植骨融合内固定术治疗影像学不典型的腰椎间盘突出症的临床疗效。方法症状侧入路通道下减压并植骨融合内固定术治疗影像学不典型的腰椎间盘突出症患者23例,其中男15例,女8例;年龄32~58岁,平均年龄43.8岁。在术前、术后即刻以及术后3、6个月、末次随访时采用视觉模拟评分(visual analogue scale,VAS)、功能障碍指数(oswestry disability index,ODI)评分以及改良Mac Nab标准评价临床疗效。结果所有患者均获随访,随访时间12~36个月,平均21.3个月。术后即刻以及术后3、6个月、末次随访时间点的VAS评分和ODI评分和术前比较,差异有统计学意义(P<0.05)。改良Mac Nab标准评分为优17例,良4例,可1例,优良率95.6%(22/23)。切口均达到Ⅰ级愈合,无一例发生神经根马尾神经损伤、感染、大血管损伤、硬膜囊撕裂等并发症。2例术后1年复查CT植骨融合欠佳,但内固定无松动,无其他并发症发生。结论对于影像学不典型的腰椎间盘突出症患者,只要定位准确,采取症状侧可扩张通道下减压植骨融合术治疗,也可以获得良好的临床疗效。Objective To evaluate the clinical application and effectiveness of only transforaminal lumbar interbody fusion（ TLIF） from symptomatic side with quadrant minimally invasive system for lumbar disc herniation with atypical radiographic view. Methods 23 patients with lumbar disc herniation with atypical radiographic view were diagnosed,including male 15,female 8; age from 32 - 58 y（ average43. 8 y）. These patients were treated with TLIF from symptomatic side plus quadrant minimally invasive system. The clinical results were evaluated by using visual analogue scale（ VAS）,Oswestry disability index（ ODI） and Mac Nab criteria at pre-operation,postoperation,3 months and 6 months after surgery. Results All patients were followed up for 21. 3 months on average（ range,12 - 36 months）. Postoperative VAS and ODI score were significantly improved than before. According to Mac Nab criteria,the therapeutic outcomes were excellent in 17 cases,good in 4 cases,fine in 1 cases,with the excellent and good rate of95. 6%（ 22/23）. The bone unions were not good only in two cases at one year after surgery,no other serve complications happened. Conclusion For lumbar disc herniation patients with atypical radiographic view,positioning accurately and TLIF from symptomatic side plus quadrant minimally invasive system could obtain satisfactory outcome.

关 键 词：症状侧入路 减压植骨融合术 影像学不典型 腰椎间盘突出症 

分 类 号：R687.3[医药卫生—骨科学]