腰椎间盘突出分类与手术方式选择

The Classification and Choice of Operative Technique on Lumbar Disc Herniation

目的探讨老年腰椎间盘突出的解剖特点、临床分类、手术方式选择及疗效。方法回顾性分析60岁以上腰椎间盘突出症36例,综合临床表现、腰椎CT将其分为3型;Ⅰ、Ⅱ型采用单侧或双侧开窗减压、髓核摘除;Ⅲ型采用全椎板减压髓核摘除。结果Ⅰ型8例(22.2%),Ⅱ型22例(61.1%),Ⅲ型6例(16.7%)。手术效果按王福权分级法:优26例(72.2%),良6例(16.7%),可4例(11.1%)。结论老年腰椎间盘突出症Ⅰ、Ⅱ型患者占绝大多数,单侧或双侧开窗减压髓核摘除可以达到较好的治疗效果。

Objective To study anatomy characteristic ,clinical classification ,operative technique and outcome about old lumbar disc herniation. Methods 36 cases patients over 60 years old of lumbar disc herniation from April 1999 to April 2004 was classified as 3 types according to clinical symptom and lumbar CT. Type Ⅰ and Ⅱ use single or double side fenestration ,discoidectomy. Type Ⅲ use laminectomy, discoidectomy. Results Of these cases, Type Ⅰ were 8 （22.2%） ; Type Ⅱ 22 （61.1%） ; Type Ⅲ 6 （16.7%） . Depending on Wang Fuquang grade：excerlent 26 （72.2%） ,good 6（ 16.7% ） ,fair 4（ 11.1% ）. Conclusion The most patients of old lumbar disc herniation belong to Type. Ⅰ or Ⅱ . Effect is good through single or double side fenestration, discoidectomy.