前后路减压植骨融合内固定术治疗高位腰椎间盘突出症的比较研究

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1、前后路减压植骨融合内固定术治疗高位腰椎间盘突出症的比较研究【摘要】评价比较前后路减压植骨融合内固定术治疗高位腰椎间盘突出症的手术疗效。［方法］47例患者(男29例，女18例)平均年龄53.3岁，平均随访（53.5±5）个月。25例行双侧小关节切除自体小关节骨质及Cage后路椎间植骨椎弓根钉内固定术(后路组)，22例行前路椎间盘切除植骨融合钛板内固定术(前路组)。比较两组患者的临床治疗基本情况，采用临床功能评估标准进行临床疗效评估，并评价两组患者术前及术后随访时放射学结果及手术并发症。［结果］在手术时间及术

2、中出血量上经后方椎板切除入路优于前外侧入路，在临床症状改善率以及神经损伤发生率上两种手术方式没有显著差异性。后路组术中3例硬脊膜撕裂，1例椎弓根位置偏斜，随访时骨性融合率96.00%。前路组术中2例硬脊膜破裂，3例术后单侧神经根麻痹，1例术后出现难以控制性呃逆，随访时骨性融合率95.45%。［结论］高位腰椎间盘突出症手术治疗是必要的，经后方椎板切除入路可以缩短手术时间，减少术中出血量，是治疗高位腰椎间盘突出症的理想方法。【关键词】腰椎间盘突出症高位融合术手术疗效Abstract:［Objective］To

3、evaluatethecurativeeffectsoftheposteriororanteriorlumbarinterbodyfusionforthetreatmentofsuperiorpositionintervertebraldischerniation.12［Method］Forty-sevenpatientswithsuperiorpositionintervertebraldischerniationwerefollowedup.Therewere29malesand18femaleswi

4、thmeanageof53.3years(from35to67years).Twewty-fivepatientsweretreatedwithposteriorlumbarinterbodyfusion(PLIF)usingfacetjointautograftandcageadditionalofpediclescrewinternalfixation(posteriorwaygroup),and22patientsweretreatedwithanteriordisckectomy,bonegraf

5、tandplatesinternalfixation(anteriorwaygroup).Themeanfollow-uptimewas53.5±5months(from24to78months).Theclinicalresultswerecomparedbetweentwogroups.Clinicalfunctionalassessmentstandardwasusedtoevaluatetheclinicalcurativeeffect.Thechangesofthetherapeuticeffe

6、cts,theradiographicfindingsandcomplicationswereevaluated.［Result］Inregardtotheoperationtimeandbleeding,theposteriorwaygroupwassuperiortoanteriorwaygroup.Therewasnodifferencebetweenthetwogroupsinclinicalrecoveryratesandnerverootinjuryrates.Complicationsinc

7、ludedduraltear(n=3),andpediclescrewdeviating(n=1)intheposteriorwaygroup;andduraltear(n=2),unilateraltransientlowerextremityparesthesia(n=3),andhardcontrolledsingultation(n=1)intheanteriorwaygroup.Theratesofbonefusionwere96.00%and95.45%inthe12posterioranda

8、nteriorwaygroups.［Conclusion］Operationforthesuperiorpositionintervertebraldischerniationiseffective.Theposteriorlumbarinterbodyfusionusingfacetjointautograftandcageadditionalofpediclescrewinternalfixationtoshortenth