极外侧型腰椎间盘突出症椎旁肌间隙入路与后正中入路的病例对照研究

摘要

Objective:To compare the clinical outcomes of intrasacrospinal muscular approach and posterior midline ap-proach in treating far lateral lumbar disc herniation. Methods:The clinical data of 32 patients with far lateral lumbar disc her-niation underwent transforaminal lumbar interbody fusion from January 2004 to January 2011 were retrospectively analyzed. The patients were divided into intrasacrospinal muscular approach group (11 males and 6 females ) and posterior midline ap-proach group (10 males and 5 females). All patients were followed up from 12 to 18 months with an average of 15.3 months. Operative time,blood loss,postoperative draining volume were recorded and pre and post operative visual analog scale (VAS) and Oswestry Disability Index (ODI) were compared between two groups. Results:Operative time,blood loss,postoperative draining volume in intrasacrospinal muscular approach group was less than that of posterior midline approach group (P<0.05). There was no significant difference in VAS at final follow up between two groups(P>0.05);and the mean ODI in intrasacrospinal muscular approach group was less than that of posterior midline approach group (P<0.05). Conclusion:For the treatment of far lateral lumbar disc herniation,intrasacrospinal muscular approach has less injury for paraspinal muscle and more satisfactory clinical outcome and is better method than posterior midline approach.%目的：比较经椎旁肌间隙入路与后正中入路对极外型腰椎间盘突出症手术疗效的影响。方法：回顾分析2004年1月至2011年1月收治的32例行手术治疗的极外侧型腰椎间盘突出症患者的临床资料。其中行椎旁肌间隙入路17例，男11例，女6例；后正中入路15例，男10例，女5例，均经椎间孔腰椎椎体间融合术（transforaminal lum-bar interbody fusion，TLIF）治疗。所有患者获得随访，时间12～18个月，平均15．3个月。记录手术时间、术中出血量和术后引流量，并比较两组术前术后的疼痛视觉模拟（visual analogue scale，VAS）评分和Oswestry 功能障碍指数（Oswestry Disability Index，ODI）。结果：椎旁肌间隙入路组手术时间、术中出血量及术后引流量明显少于后正中入路组（P＜0．05）。末次随访时两组间VAS评分比较差异无统计学意义（P＞0．05），椎旁肌间隙入路组ODI评分少于后正中入路组（P＜0．05）。结论：极外型腰椎间盘突出症经椎旁肌间隙入路比传统后正中入路对椎旁肌损伤更小，具有更好的临床疗效。