微创可扩张通道下腰椎间盘切除结合椎间孔腰椎融合术治疗极外侧腰椎间盘突出症的疗效

摘要

Objective Toevaluatetheclinicaleffectofdiscectomy and TLIFinthe treatment of farlaterallumbardisc herniation(FLLDH) with MASTTMQUADRANTT Mminimally invasive channel.Methods 24casesofFLLDHadmittedtothede-partment of spinal surgery of Taihe Hospital in Shiyan,Hubei Province from March 2011 to January 2013 were given discectomy and TLIF. The scores of lumbar JOA before and after operation were analyzed,and the TLIF effect was evaluated by using modi-fiedMacNadcriterion.Results Allthe24patientswerefollowedupforsixmonthstotwoyears,withanaverageof14 months. The average JOA score of the 17 cases of foraminal disc herniation was(8. 24 ±3. 15)before operation,and was (24. 23±2. 15)during the follow up,showing statistically significant difference(t=17. 287,P=0. 000). The average JOA score of the 7 cases of extraforaminal disc herniation was(9. 35 ±3. 23),and was(23. 89 ±2. 55)after operation,showing statistically significant difference(t=9. 378,P=0. 000). The evaluation results of MacNad showed that 12 cases were excel-lent,9 cases were good and 3 cases were fair,with an overall excellent and good results rate of 87. 5%. Anteroposterior imagings and CT of lumbar showed that interbody fusion was good and there were no instances of postoperative wound infection or nerve in-juryinanygroup.℅onclusion TheoperationofdiscectomyandTLIFinthetreatmentofFLLDHwithminimallyinvasivechannel is an effective method,which has less tissue trauma,less complications and satisfactory clinical results.%目的：在MASTTM QUADRANTTM微创可扩张通道下对极外侧型腰椎间盘突出症（ FLLDH）行突出椎间盘切除、椎间孔腰椎融合术（ TLIF）治疗，观察其疗效。方法选取2011年3月-2013年1月湖北省十堰市太和医院脊柱外科收治并确诊的24例FLLDH患者行突出椎间盘切除结合TLIF，对患者术前、术后的腰椎日本骨科协会（ JOA）评分和MacNad疗效评定标准进行分析，评价疗效。结果本组24例患者均获得随访，随访时间为6个月~2年，平均14个月，椎间孔型17例，术前JOA评分平均（8.24±3.15）分，术后平均（24.23±2.15）分，术前术后JOA评分比较有差异（t越17.287，P越0.000）；椎间孔外型7例，术前JOA评分平均（9.35±3.23）分，术后平均（23.89±2.55）分，术前术后JOA评分比较有差异（t越9.378，P越0.000）；MacNad评定结果：优12例、良9例、可3例；优良率为87.5%（21/24）。复查腰椎正侧位片、腰椎CT显示植骨愈合良好、椎间隙无明显塌陷、内固定物无松动。所有患者术后伤口一期愈合，未出现神经损伤并发症。结论微创可扩张通道下对 FLLDH的突出椎间盘切除并行TLIF，手术操作方便，疗效可靠，是一种较好的手术方法。