一侧椎板开窗棘突切除术治疗中央型腰椎间盘突出症

Fenestration with the spinous process resection in the treatment of central protrusion of lumbar intervertebral disc

目的:探讨一种改良的治疗中央型腰椎间盘突出症的手术方法和疗效。方法:1999年2月至2005年12月,对34例中央型腰椎间盘突出症患者采用改良的手术方式治疗。男25例,女9例;年龄35～63岁,平均46.4岁。病变部位:L4,5突出20例,L5S114例。症状表现一侧下肢痛重、对侧下肢痛轻21例;最初一侧下肢痛,后转为以对侧下肢麻痛重为主,而最初一侧下肢痛变轻者8例;双侧下肢痛无明显差异5例。术前CT影像显示椎间盘突出正中央型8例,旁中央型26例。手术在一侧椎板开窗术的基础上,咬除相应棘突,保留棘上韧带,并将棘上韧带牵向对侧,使椎管显露扩大,摘除中央突出之椎间盘,称之为"一侧椎板开窗棘突切除术"。结果:34例均得到随访,时间1～5年,采用侯树勋疗效评价标准,优20例,良11例,可3例,优良率91.2%。结论:一侧椎板开窗棘突切除术既达到椎管减压、摘除突出之椎间盘的目的,又保留了对侧椎板、棘上韧带,维持了后柱稳定,为治疗中央型腰椎间盘突出症提供了一种改良新术式。

Objective：To explore a operative approach and its effect to the central protrusion of lumbar intervertebral disc. Methods：From February 1999 to December 2005,34 patients with central protrusion of lumbar intervertebral disc were treated with an improved operative procedure. The study involved 25 males and 9 females with an average of 46.4 years （range,35 to 63 years）. The involved level of herniation were at L4.5 in 20 cases and L5S1 in 14 cases. Pains happened on one leg fixedly and seriously with another lightly in 21 cases ,on one leg initially and lightly with another seriously later in 8 cases, on bilateral legs alike in 5 cases. Preoperative CT film showed central type in 8 cases and laterocentral type in 26 cases. The corresponding spinous process was resected on the basis of unilateral fenestration. The supraspinous ligament was rerained and pulled to the opposite side for revealing spinal canal, and then diskectomy was done. The above procedure was named ＂fenestration with the spinous process resection＂. Results：All the 34 patients were followed up for 1 to 5 years.The outcome was evaluated according to the standard of HOU Shu-xun,20 cases were excellent, 11 good and 3 fair. The total rate of excellent and good was 91.2%. Condusion：The＂fenestration with the spinous process resection＂ not only completed decompression of spinal canal and diskectomy, but also retained opposite lamina and supraspinous ligament and maintained the stability of posterior vertebral column,which are a new improved approach for the central protrusion of lumbar intervertebral disc.