腰椎间盘突出症合并腰椎管狭窄有限开窗治疗分析

Limited window for treatment of lumbar disc herniation with spinal stenosis

目的探讨腰椎间盘突出症合并椎管狭窄行有限开窗手术治疗的临床疗效。方法回顾性分析2004年2月～2010年8月在我科行手术治疗的134例腰椎间盘突出症的临床资料,其中手术证实合并腰椎管狭窄45例,采用椎板间潜行有限开窗,侧隐窝及神经根管减压治疗。结果随访时间1～4年,平均随访2.5年,根据日本骨科学会(JOA)下腰痛评分标准,45例腰椎间盘突出合并腰椎管狭窄中,优36例(80%),良7例(11%),可2例(8%),未发现腰椎继发性不稳及椎管再狭窄。结论腰椎间盘突出症合并腰椎管狭窄时,不能遗漏诊断导致手术减压不彻底,用有限开窗侧隐窝及神经根管减压处理,手术创伤小、对脊柱后柱结构破坏小,能达到满意疗效。

Objective To investigate the lumbar disc herniation combined with spinal stenosis limited fenestration operation treatment.Methods A retrospective analysis of 2004 February to 2010 August in our department line operation in treatment of 134 cases of lumbar disc herniation clinical data,where in the operation confirmed with lumbar spinal canal stenosis in 45 cases,using stealth limited fenestration laminectomy,lateral recess and nerve root canal decompression for the treatment.Results Follow-up of 1 to 4 years,the mean follow-up of 2.5 years,according to the Japanese Orthopaedic Association(JOA)low back pain score,45 cases of lumbar disc herniation combined with lumbar spinal stenosis,and 36 cases(80%),good in 7 cases(11%),2 cases(8%),did not discover lumbar secondary instability and spinal canal stenosis.Conclusion Lumbar disc herniation and lumbar canal stenosis,not omission diagnosis leads to incomplete decompression operation,with limited fenestration of lateral recess and nerve root decompression processing,small operation wound,little damage to the posterior column structure,can achieve satisfactory effect.