不同手术入路行椎间盘切除术对胸腰段椎间盘 突出症疗效及安全性的影响

目的 比较侧前方入路与侧后方入路行椎间盘切除术对胸腰段椎间盘突出症患者疗效、创伤性及预后的影响，期望为合理选择手术入路提供依据。 方法 选择杭州师范大学附属医院自2016年1月—2019年3月接诊的136例拟行椎间盘切除术的胸腰段椎间盘突出症患者作为研究对象，采用随机数字表法随机分为A组和B组，各68例；在手术入路的选择上，A组采取侧前方入路，B组采取侧后方入路；记录2组围术期各项信息，随访6个月，比较2组不同时间点的视觉模拟评分法(VAS)评分、Oswestry功能障碍指数问卷表(ODI)指数，观察并发症发生情况。 结果 B组住院时间为(10.81±2.04) d，短于A组的(13.57±2.79) d，术中出血量为(550.18±32.27) mL，少于A组的(746.81±23.29) mL，术后引流量为(144.75±30.92) mL，少于A组的(214.01±21.89) mL，差异均有统计学意义(t=6.593、40.738、15.076，均P<0.001)；所有患者均获得随访，2组术后1个月和6个月的VAS评分、ODI指数均较术前明显降低，变化趋势相同；所有患者均顺利完成手术，症状明显缓解，未见神经系统并发症和复发病例，B组并发症发生率为11.76%，明显低于A组的25.00%，差异有统计学意义(P＜0.05)。 结论 侧前方入路和侧后方入路行椎间盘切除术治疗胸腰段椎间盘突出症均可获得满意的疗效，后者在减轻手术创伤和减少并发症发生上具有优势，值得临床予以重视应用。 

The effect of discectomy with different surgical approaches on the efficacy and safety of thoracolumbar disc herniation

Objective To compare the effects of discectomy with lateral anterior approach and lateral posterior approach on the efficacy, trauma and prognosis of patients with thoracolumbar disc herniation, in the hope of providing a basis for the reasonable choice of surgical approach. Methods Total 136 patients with thoracolumbar disc herniation to be treated by discectomy in our hospital from January 2016 to March 2019 were selected as the research objects, who were randomly divided into group A and group B with random number table method, 68 cases in each group. In the selection of surgical approach, the group A adopted lateral anterior approach, and the group B adopted lateral posterior approach. The information of perioperative period was recorded, and followed up for 6 months. The Visual analogue score (VAS) and Oswestry disability index (ODI) of the two groups were compared, and the complications was observed. Results The hospital stay of group B was (10.81±2.04) d, shorter than that of group A (13.57±2.79) d, intraoperative blood loss was (550.18±32.27) mL, less than group A (746.81±23.29) mL, the drainage volume was (144.75±30.92) mL, less than group A (214.01±21.89) mL, and the differences were statistically significant (t=6.593, 40.738, 15.076, all P<0.001). All patients were followed up, the VAS score and ODI index of the two groups at 1 and 6 months after the operation were significantly reduced compared with those before the operation, the change trend was the same. All patients successfully completed the operation, the symptoms were significantly relieved, and there were no neurological complications and recurrence cases, the incidence of complications in group B was 11.76%, significantly lower than 25.00% in group A (P<0.05). Conclusion The treatment of thoracolumbar disc herniation by lateral anterior approach and lateral posterior approach can achieve satisfactory results, and the latter has advantages in reducing surgical trauma and complications, which is worthy of clinical attention.