中华临床医师杂志（电子版）
中華臨床醫師雜誌（電子版）
중화림상의사잡지（전자판）
CHINESE JOURNAL OF CLINICIANS(ELECTRONIC VERSION)
2015年
2期
231-234
,共4页
徐兆万%吴沁民%戴伟华%隋国侠%冀旭斌%庄青山%Zhuang Qingshan
徐兆萬%吳沁民%戴偉華%隋國俠%冀旭斌%莊青山%Zhuang Qingshan
서조만%오심민%대위화%수국협%기욱빈%장청산%Zhuang Qingshan
椎间盘移位%椎间盘切除术%手术入路%手术治疗
椎間盤移位%椎間盤切除術%手術入路%手術治療
추간반이위%추간반절제술%수술입로%수술치료
Intervertebral disk displacement%Discectomy%Surgical approach%Surgical treatment
目的：探讨经Wiltse入路治疗硬化性胸腰段椎间盘突出症的手术方法及临床疗效。方法2010年7月至2014年6月，治疗23例硬化性胸腰段椎间盘突出症患者，男17例，女6例；年龄19～71岁，平均（42.9±23.36）岁。椎间盘突出的节段：T 10/112例，T 11/128例，T 12/L110例，L1/23例。所有病例均为单节段硬化性椎间盘突出，不合并黄韧带骨化或肥厚。手术均采用经Wiltse入路切除硬化突出椎间盘。结果手术均顺利完成，1例患者（T 10/11）术后运动障碍加重，经甲强龙、脱水剂、营养神经药物治疗后恢复至术前水平。术后X线片显示内固定位置良好，CT显示突出物切除彻底。随访时间3～36个月，平均（19.8±15.72）个月。术后神经功能均获不同程度恢复。手术疗效评价参照改良M acnab疗效评定标准，其中优13例，良7例，可2例，差1例，优良率86.96%（20/23），总有效率95.65%（22/23）。均获得骨性融合，无内固定松动断裂等并发症发生。结论经Wiltse入路切除突出硬化的胸腰段椎间盘可获得满意疗效。
目的：探討經Wiltse入路治療硬化性胸腰段椎間盤突齣癥的手術方法及臨床療效。方法2010年7月至2014年6月，治療23例硬化性胸腰段椎間盤突齣癥患者，男17例，女6例；年齡19～71歲，平均（42.9±23.36）歲。椎間盤突齣的節段：T 10/112例，T 11/128例，T 12/L110例，L1/23例。所有病例均為單節段硬化性椎間盤突齣，不閤併黃韌帶骨化或肥厚。手術均採用經Wiltse入路切除硬化突齣椎間盤。結果手術均順利完成，1例患者（T 10/11）術後運動障礙加重，經甲彊龍、脫水劑、營養神經藥物治療後恢複至術前水平。術後X線片顯示內固定位置良好，CT顯示突齣物切除徹底。隨訪時間3～36箇月，平均（19.8±15.72）箇月。術後神經功能均穫不同程度恢複。手術療效評價參照改良M acnab療效評定標準，其中優13例，良7例，可2例，差1例，優良率86.96%（20/23），總有效率95.65%（22/23）。均穫得骨性融閤，無內固定鬆動斷裂等併髮癥髮生。結論經Wiltse入路切除突齣硬化的胸腰段椎間盤可穫得滿意療效。
목적：탐토경Wiltse입로치료경화성흉요단추간반돌출증적수술방법급림상료효。방법2010년7월지2014년6월，치료23례경화성흉요단추간반돌출증환자，남17례，녀6례；년령19～71세，평균（42.9±23.36）세。추간반돌출적절단：T 10/112례，T 11/128례，T 12/L110례，L1/23례。소유병례균위단절단경화성추간반돌출，불합병황인대골화혹비후。수술균채용경Wiltse입로절제경화돌출추간반。결과수술균순리완성，1례환자（T 10/11）술후운동장애가중，경갑강룡、탈수제、영양신경약물치료후회복지술전수평。술후X선편현시내고정위치량호，CT현시돌출물절제철저。수방시간3～36개월，평균（19.8±15.72）개월。술후신경공능균획불동정도회복。수술료효평개삼조개량M acnab료효평정표준，기중우13례，량7례，가2례，차1례，우량솔86.96%（20/23），총유효솔95.65%（22/23）。균획득골성융합，무내고정송동단렬등병발증발생。결론경Wiltse입로절제돌출경화적흉요단추간반가획득만의료효。
Objective To evaluate the clinical effect of sclerosing thoracolumbar discectomy via Wiltse approach in the treatment of sclerosing thoracolumbar disc herniation. Methods Twenty-three cases were included in this group from July 2010 to June 2014. There were 17 males and 6 females. The age ranged from 19 to 71 years old, with an average of 42.9±23.36 years. The section of disc herniation located in T10/11 for 2 cases, T11/12 for 8, T12/L1 for 10, L1/2 for 3. All cases were single segment sclerosing disc herniation. No one was associated with ossification or hypertrophy of yellow ligament. All the sclerosing herniated discs were excised via the Wiltse approach. Results All patients had successful operations, one case (T10/11) appeared exacerbation of preexisting deficits after operation. The patient was treated with methylprednisolone, dehydrant and neural nutrition. After treatment, the patient had recovered to preoperative level. X-ray showed no malposition of internal fixation, CT scan showed complete removal of compressor. All 23 patients were followed up for an average of 19.8±15.72 months(range 3 to 36 months). All patients had neurofunction recovered to some extent. According to improved Macnab criteria, there were excellent in 13 cases, good in 7 cases, improved in 2 cases and poor in 1 case. The excellent and good rate was 86.96%and total effective rate was 95.65%. All got bony fusion without instrument failure. Conclusion Sclerosing thoracolumbar discectomy via Wiltse approach can improve the clinical result obviously.
