椎板间入路治疗腰椎间盘突出症

Interlaminar micro-neurosurgical discectomy in lumbar disk herniation

目的研究椎板间入路显微椎间盘切除术治疗腰椎间盘突出症的手术效果。方法对36例病人行显微椎间盘切除术，术中对椎间盘碎片及纤维环缺损情况进行评估，分析术前资料和术后随访情况。结果椎板间入路在28例（78％）病人中可充分暴露椎间隙，部分椎间孔扩大术在17例（47％）病人中使用。碎片一裂隙型及碎片，包含型病人手术效果最好，复发率低。结论椎板间入路是治疗腰椎间盘突出症的一种安全、有效的手术技术，椎间盘突出类型及椎间盘切除术后纤维环的完整性对预测腰腿痛复发有价值。

Objective To investigate the surgical results of interlaminar microsurgical discectomy in lumbar disk herniation. Method A study of 36 consecutive patients undergoing microsurgical lumbar discectomy was conducted. The extend of anular deficiency and the presence of disc fragment were determined. The clinical radiological parameters, type of surgery performed follow up were assessed. Results We found that interlaminar disectomy without laminotomy was adequate in 28 eases （78%）. Seletive toraminotomy in addition to discectomy was performed in 17 cases （47%）. Patients in the Fragment-Fissure and Fragment-Contained group had the best clinical outcomes, and lower rates of reherniation. Conclusions Interlaminar discectomy without laminotomv is a safe, effective and reliable surgical technique for treating lumbar disc herniation. The degree of anular competence after discectomy and the type of herniation appear to have value for prediction of recurrence of asciatica.