扩大的椎板间开窗治疗腰椎间盘突出伴侧隐窝狭窄(附140例报告)

Treatment of Lumbar Lateral Recess Stenosis with Disc Herniation by Enlarged Fenestration

本组采用的扩大的椎板开窗术治疗腰椎间盘突出合并侧隐窝狭窄140例。结果全部优良，与适应症严格选择和手术损伤小有关。强调切除卡压神经根的侧隐窝后壁外侧，即上关节突的冠状面．不失其脊椎三柱系统的三角结构。俯卧位头低足高，可减少硬膜囊张力避免负损伤。切除棘突下椎板时，用神经拉勾代替神经剥离器易于分离黄韧带，用90度的椎板咬骨钳斜向棘突方向，可满意地切除该部份椎板黄韧带，并可刮切椎板内层。神经根周围滴入醋酸炎舒松A2-3ml，术后疼痛锐减。减压窗口置盖明胶海绵有其争议，作者实践体会放置害处不大，要求病人有“护腰”意识。

140 patients who had suffered from lumbar lateral recess stenosis with disc herniation were treated by enlarged fenestration from January 1994 to December 1995. The range of opening decompression included, up to the starting of the nerve root, down to the enter of bony canal for the nerve root (0. 5 - 1. 0cm), lateral to the wall of the pedicle. All of the patients were followed up from three to twenty-four months after the operation, the excellent and good rate is 100%, the results showed that enlarged opening decompression using for the patients, is convenient, thorough decompression and good spine stability after the operation.