腰椎间盘突出症CT、MRI特征与术式选择(附286例报告)

CT, MRI Feature of Herniated Lumbar Intervertebral Discs and Operation Types Selection

[目的]探索腰椎间盘突出症CT、MRI特征及其术式选择.[方法]对286例腰椎间盘突出的患者依据不同的临床分型和CT、MRI特征,选择不同的手术方式,术后随访1～5年(平均2.7年)观察其临床疗效.[结果]对不伴有椎管狭窄的患者选用椎板开窗髓核摘除术;有椎管狭窄者扩大椎间孔,充分减压.根据Nilai标准评定,286例患者手术治疗优良率达94%.[结论]腰椎间盘突出症手术治疗的首选术式为椎板间开窗髓核摘除,其创伤小,不损害脊柱稳定性,术后功能恢复快;年龄与疗效有关,60岁以上与60岁以下组的手术优良率差异有显著性(P<0.05).

To explore the CT, MRI characteristics of protruded lumbar intervertebral discs and their operation selections.Defferent types of operation were selected in 286 patients of herniated lumbar intervertebral discs according to cliniacal patterns and CT,MRI features .Clinical results were observed for 1-5( average 2.7 )years.In cases without neural canal stenosis ,window was made between relevant neighboring laminae arcus vertebrae and herniated nucleus pulposus was removed . In cases with canal stenosis ,total laminectomy was performed and intervertebral foramen enlarged for full decompression. According to Nilai evaluation standard, the total operative excellent and good effective rates were 94%. [Conclusion] Partial laminectomy to remove the herniated nucleus pulposi is the operation of first choice for patients with lumbar intervertebral disc protrusion .This type of operation has the advantages of less trauma with rapid recovery of function and stability of spinal vertebrae. Efficacy rates varies with age. Patients below 60 years old have better result than those over 60 years old.