后路全椎板减压椎间融合术治疗腰椎间盘突出症合并椎间不稳的疗效观察

Effect of Vertebral Plate Resection and Disc Excision from Posterior Approach Combined with Lumbar Interbody Fusion for Treatment of Lumbar Disc Herniation Associated with Lumbar Instability

【目的】探讨腰椎间盘突出症合并椎间不稳手术适应症的选择及手术疗效。【方法】对58例经系统保守治疗或单纯开窗减压髓核摘除术治疗后效果不佳的腰椎间盘突出症合并椎间不稳患者,均行后路全椎板减压椎间植骨融合椎弓根螺钉内固定术治疗。【结果】54例获得随访,平均随访13个月,根据日本骨科学会(JOA)评分标准评估:优37例,良13例,一般4例,优良率达92.59%。术后3个月经X线摄片检查,52例椎间植骨融合,植骨融合率达96.30%。【结论】腰椎间盘突出症合并椎间不稳患者,宜行后路全椎板减压椎间植骨融合椎弓根螺钉内固定术,其疗效令人满意。

[ Objective ] To assess the indications and therapeutic effect of surgical treatment for lumbar disc herniation （LDH） associated with lumbar degenerative instability （LDI）. [ Methods ] Fifty-eight LDH associated with LDI patients, which were ineffective after strictly conservative treatment or simple decompression with disc excision, received lumbar vertebral plate resection and disc excision from posterior approach, and transpedicular screw fixation combined with posterior lumbar interbody fusion. [ Results] A averaged 13-month follow-up was carried out in 54 patients. The therapeutic effect assessed by Japanese Orthopaedics Association （JOA） was as follows： excellent in 37 patients, good in 13, ordinary in 4, and the excellent ＋ good rate was 92.59%. The results of X radiography 3 months after the operation showed that lumbar interbody fusion was successful in 52 patients, the infusion rating being 96. 30%. [ Conclusion] Lumbar vertebral plate resection and disc excision from posterior approach, and transpedicular screw fixation combined with posterior lumbar interbody fusion are effective for the treatment of LDH associated with LDI.