腰骶神经根损害发病特点及其外科治疗的临床研究

Lumbosacral spine nerve root injury characteristics of the disease and its surgical treatment of clinical study

目的探讨腰骶神经根损害的临床特点和手术时机的选择及如何制定正确的治疗方案。方法我院收治的资料完整的腰椎间盘突出症和腰椎管狭窄症致腰神经根压迫造成的下腰痛患者共60例,均排除先天异常、结核、肿瘤、外伤。男38例、女22例。年龄23～70岁,平均46岁。16例单纯腰椎间盘突出症患者中9例行椎板开窗髓核摘除神经根减压术;42例腰椎间盘突出症合并不同程度腰椎管狭窄症患者,均行腰椎后路全椎板切除减压、椎间植骨或植入椎间融合器融合、椎弓根钉内固定术。结果60例患者均予术后3个月、6个月及1年复查腰椎正侧位片、腰椎屈伸侧位片。结果显示腰椎生理曲度恢复,内固定椎弓根钉及连接杆位置良好,固定节段植骨得到融合。无一例患者发生断钉、断棒及椎间隙变窄改变。疗效评定总体优良率为88%。结论手术减压的时机选择尽量做到早期手术、积极争取中期、绝对避免晚期,彻底的椎管及背根结的减压是提高手术疗效的关键。

Objective Discussion of lumbosacral nerve root injury to the clinical features and surgical timing and how to develop the right treatment. Methods In our hospital,complete information lumbar disc herniation and lumbar spinal stenosis caused by spinal nerve root cause of low back pain in patients with a total of 60 cases,among them congenital anomalies,tuberculosis,cancer, trauma were excluded. 38 cases of men and women in 22 cases, the average age 46-years-old. 16 cases of simple lumbar disc herniation in patients with 9 laminectomy and diseectomy and nerve root decompression;42 cases of lumbar disc herniation combined to varying degrees in patients with lumbar spinal stenosis,both full-line of posterior lumbar laminectomy removal of decompression,interbody implants or bone fusion cage,pedicle screw fixation. Resnits 60 cases for all patients after 3 months, 6 months and 1 year review were lateral lumbar spine films,flexion and extension lateral lumbar film. The results showed that the physiological curvature of the spine to restore and internal fixation of pedicle screw position under well-connected and fixed bone segments to be integrated. None occurred in patients with broken nails,broken rods and narrowed intervertebral space to change. The overall effect of the fine assessed the rate of 88%. Conclusion Surgical decompression of the timing of the operation early as possible and to persuade the mid-late to avoid an absolute late stage,completelg open the spingl canal and dorsal root ganglion decompression is the key to impmve the efficacy.