高位腰椎间盘突出症的临床特点及术式选择

Clinical characteristics and selection of surgical treatment method for upper lumbar disc herniation

目的探讨高位腰椎间盘突出症的临床特点、诊断及手术方式的选择。方法42例高位腰椎间盘突出症患者术前均行X线检查,部分行脊髓造影、CT、MRI及肌电图辅助检查,患者均有较大的严重腰痛症状并均行手术治疗。行植骨融合术2例,切除患侧椎板外半和椎间相应关节突;行对侧椎板关节突间植骨融合2例,行后路半椎板和一侧小关节切除USS植入,椎间融合2例,余采用常规手术内固定。结果全部获随访,时间1～3年。术中硬脑膜破裂脑脊液漏3例,马尾神经损伤2例。疗效评价参照Nakanoetal腰腿病疗效评定标准以及Stauffer标准评价疗效:优35例,良5例,差2例,优良率为95.2%。结论高位腰椎间盘突出症的临床表现复杂,手术入路应根据上腰椎的解剖特点及影像学显示椎间盘突出的部位决定手术方式。

Objective To explore the clinical characteristics and diagnosing and treatment methods of the upper lumbar disc herniation, Methods 42 patients of upper lumbar disc herniation with significant low back pain were undergone X-ray test and partial intraspinal angiography, CT, MRI and EMG before surgery treatment. 2 cases with bone graft fusion were resected lateral part of lesion vertebral lamina and process; 2 cases were treated with contralateral interarticular process and vertebral lamina bone graft fusion; 2 cases with intervertebral fusion were treated by laminectomy and arthrectomy of one side by posterior route and USS implantation ; Other cases were treated with routine internal fixation. Results All patients were followed up for 1 - 3 years, 5 cases got complications, of which 3 cases were with leakage of cerebrospinal fluid and 2 cases with cauda equina injury, According to the evaluation system of Nakano et al and Stauffer, the results were excellent in 35 cases, good in 5 and fair in 2, and the excellent and good rate was 95.2%, Conclusions The clinical manifestations of upper lumbar disc herniation are complicated. The approach of operation should be determined by the features of upper lumbar vertebrae anatomy and the site of herniation discs according to radiograph,