极外侧型腰椎间盘突出症的临床特征及术式选择

Clinical Features and Choice of Operative Approach of Extreme Lateral Lumbar Disc Herniation

【目的】分析极外侧型腰椎间盘突出症的临床特征,探讨其合理的手术治疗方式。【方法】回顾性分析2003年5月至2007年5月在本院经手术证实的17例极外侧型椎间盘突出症的临床资料,分别采用经椎板间开窗途径,经椎板、峡部及关节突切除途径,经峡部外缘途径三种术式进行手术治疗。【结果】本组17例,均经手术治疗,随访6~18个月,平均11.2个月。采用Macnab疗效评定标准,优12例,良4例,可1例,差无。优良率为94.1%。【结论】高质量CT检查可清楚显示位于椎间孔或孔外缘突出的椎间盘组织,这对于诊断及指导手术有重要价值。临床工作中应重视临床与影像学资料的结合以提高诊断的准确性。同时一经确诊,应尽早手术治疗。手术治疗应根据具体病例的病理解剖学特点选用最为安全、有效的个体化术式。

[Objective]To investigate the clinical features of extreme lateral lumbar disc herniation and evaluate the rational operative techniques. [Methods] A retrospective analysis was made on the clinical data of the 17 cases with far lateral lumbar disc herniation operated in our hospital during May of 2003 to May of 2007. Three various operative approaches were adopted to treat the disorder in different styles, including the translaminar osteotomy, the approach from the laminar, par interarticularis and articular process and the approach from the outer edge of par interarticularis. [Results]All the 17 cases were operated and followed up for 11.2 months on average （during 6 months to 18 months）. According to the Macnab standard, the excellent and good rate was 94.1% with excellent 12 cases, good 4 cases, acceptable 1 case and no poor case. [Conclusion] CT scanning of high quality can show the protruded disc in and outside of the foramen clearly. It is of great value for diagnosis and guidance of surgery. Surgical treatment should be chosen as soon as possible once diag- nosis is made. We should choose the most safe, efficient and individual approaches to treat them surgically according to the pathological anatomical characteristics of specific case.