Liao Xuyu, Yang Qingguo, Zhang Jianxiang, Shen Cailiang, Tang Jian, Hua Xingyi, Zhang Yinshun, Dong Fulong
The Third Department of Orthopaedics, the First Affiliated Hospital of Anhui Medical University, Hefei Anhui, 230032, P.R. China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2009 Dec;23(12):1418-21.
To evaluate the effect of anterolateral approach in treating thoracolumbar disc protrusion.
From May 2004 to May 2008, 11 patients with thoracolumbar disc protrusion (T10-L3) underwent discectomy, autologous iliac bone graft, and internal fixation via anterolateral approach. There were 9 males and 2 females aged 26-57 years old (average 42.8 years old). The course of disease was 1 week-11 years (average 2.7 years). Nine patients showed the lower limbs weakness, 8 had sensory disturbance, 6 presented with lumbodorsal pain, 5 had the lower limb pain, 4 presented with sphincter muscle disturbance, 3 suffered from foot drop, and 5 had a history of lower back injury. X-ray, CT, and MRI test showed that 9 cases had the single-segmental protrusion, 2 cases had double-segmental protrusion, 2 cases were accompanied with ossification of the thoracic vertebra yellow ligament, 2 cases were combined with ossification of the vertebra posterior longitudinal ligament, and 1 was complicated with Scheuermann disease. Preoperatively, the intervertebral height was (7.2 +/- 1.3) mm and JOA score was 6.4 +/- 2.8.
The time of operation was 2.5-5.5 hours (average 3.5 hours); the blood loss during operation was 500-1,200 mL (average 750 mL). During operation, intraoperative pleural tear occurred in 1 patient, peritoneal tear in 1 patient, and dural laceration in 1 patient. Repairing was performed intraoperative and preventive suction drainage was used for 3-5 days. No postoperative hydropneumothorax and cerebrospinal fluid leakage occurred. All incisions healed by first intention. No postoperative complications of nerve system occurred. All the patients were followed up for 1-4 years (average 2.4 years). X-ray films showed that all the patients achieved bony fusion without the occurrence breakage and loosening of titanium plate and screw 6-9 months after operation. Three cases displayed subtle scoliosis (10-15 degrees) without influence on spinal equilibration. The intervertebral height increased to (12.3 +/- 1.5) mm 2 weeks after operation, indicating there was a significant difference compared with preoperative value (P < 0.05). The intervertebral height 1 year after operation when the bony fusion was reached decreased to (7.5 +/- 1.2) mm, indicating there was no significant difference compared to the preoperative value (P > 0.05). The JOA score increased to 7.6 +/- 3.2 at 1 year after operation, indicating there was a significant difference compared with preoperative value (P < 0.05). The symptoms and signs of all the patients were improved to various degrees after operation. According to improvement rate evaluation system proposed by Hirabayashi et al., 4 cases were graded as excellent, 6 as good, 1 as fair, and the excellent and good rate was 90.9%.
Treating thoracolumbar disc protrusion via anterolateral approach is safe and effective.
评估前路手术治疗胸腰椎间盘突出症的疗效。
2004年5月至2008年5月，11例胸腰椎间盘突出症（T10-L3）患者采用前路手术行椎间盘切除术、自体髂骨植骨及内固定。其中男性9例，女性2例，年龄26-57岁（平均42.8岁）。病程1周-11年（平均2.7年）。9例患者出现下肢无力，8例有感觉障碍，6例有腰背痛，5例有下肢疼痛，4例有括约肌功能障碍，3例有足下垂，5例有腰部外伤史。X线、CT及MRI检查显示，9例为单节段突出，2例为双节段突出，2例伴有胸椎黄韧带骨化，2例合并椎体后纵韧带骨化，1例合并休门氏病。术前椎间隙高度为（7.2±1.3）mm，JOA评分为6.4±2.8。
手术时间为2.5-5.5小时（平均3.5小时）；术中出血量为500-1200 mL（平均750 mL）。术中1例患者发生胸膜撕裂，1例患者发生腹膜撕裂，1例患者发生硬脊膜撕裂。术中进行了修补，并预防性持续负压引流3-5天。术后无血气胸及脑脊液漏发生。所有切口均一期愈合。术后无神经系统并发症发生。所有患者随访1-4年（平均2.4年）。X线片显示，所有患者术后6-9个月均达到骨性融合，未发生钛板及螺钉断裂、松动。3例患者出现轻度脊柱侧弯（10-15度），未影响脊柱平衡。术后2周椎间隙高度增加至（12.3±1.5）mm，与术前相比差异有统计学意义（P<0.05）。术后1年达到骨性融合时椎间隙高度降至（7.5±1.2）mm，与术前相比差异无统计学意义（P>0.05）。术后1年JOA评分提高至7.6±3.2，与术前相比差异有统计学意义（P<0.05）。所有患者术后症状和体征均有不同程度改善。根据平林等提出的改善率评估系统，优4例，良6例，可1例，优良率为90.9%。
前路手术治疗胸腰椎间盘突出症安全有效。
