突出的腰椎间盘与神经根粘连的原因分析及处理措施

Pathogenic Factors and Surgical Treatment of Nerve Root Adhesion in Operation of Lumbar Disc Herniation

目的探讨腰椎间盘突出症术中神经根粘连的原因及处理措施。方法回顾性分析2002年12月～2008年12月,经手术治疗证实的突出椎间盘组织与神经粘连的腰椎间盘突出症85例90个间隙。单间隙80例,双间隙5例,其中行椎间盘镜下髓核摘除术5例,椎板开窗髓核摘除术30例,半椎板切除髓核摘除30例,全椎板切除髓核摘除20例;其中30例同时行植骨融合内固定术。结果腰椎间盘突出钙化30例(35.3%);腰椎间盘突出破裂25例(29.4%);椎间盘软骨板破裂症10例(11.8%);腰椎间盘突出复发5例(5.9%);一般腰椎间盘突出症15例(17.6%)。其中既往行过椎管内封闭或行经皮溶核术的5例;合并椎间隙狭窄30例;合并腰椎不稳15例。患者随访1～6年,平均2.5年,2例术后残留麻木,2例足下垂,1例术后椎间隙感染,经非手术治疗痊愈。3例术中有硬膜撕裂,1例行修补术,术后无脑脊液漏,融合内固定患者无内固定松动及断裂,融合率86.3%。按Nakai疗效评定标准:优67例,良10例,可5例,差3例,优良率90.6%。结论腰椎间盘突出症患者突出椎间盘与神经根粘连常见的原因为:腰椎间盘突出破裂、腰椎间盘突出钙化、腰椎间盘突出复发及椎间盘突出合并腰椎不稳和腰椎间盘突出既往行过椎管内注射治疗者。充分的显露、彻底松解粘连、髓核摘除及合理选择内固定可获得满意的疗效。

Objective To investigate the pathogenic factors and surgical treatment of nerve root adhesion in operation of lumbar disc herniation （LDH）.Methods From December 2002 to December 2008,a retrospective analysis was performed on 85 cases of LDH with nerve root adhesion with herniation disc that were proved by operation.Amang surgery,35 cases were total laminectomy, thirty cases were semilaminectomy, 15 cases were windowing, 5 cases were microdiscectomy with diskoscope.Thirty cases were treated with posterior lumbar interbody fusion （PLIF） technique, 10 cases treated with transforminal lumbar interbody fusion （TLIF） technique.Results Among 85 cares, 35 cases （35.3%） were calcification of lumbar intervetebral disc protrusion,25 cases （29.4%） were rupture of lumbar disc herniation, 10 cases （11.8%） were rupture of cartilaginous endplate, 5 cases（5.9%） were recurrent lumbar disc herniation and 15 cases（17.6%） were general lumbar disc herniation. All cases were followed up 1-6 years （mean, 2.5 years）.The numb of the toes did not disappear completely in 2 cases, 2 cases had footdrop, 1 case had intervertebral infection after operation, 3 cases had tear of cerebrospinal fluid. The results showed that 90.6% of the cases were graded as excellent and good by Nakais criterion.Conclusion The pathogenic factors of the nerve root adhesion with lumbar disc herination are calcification of lumbar intervetebral disc protrusion, rupture of lumbar intervetebral disc pro- trusion, rupture of cartilaginous endplate and recurrent of lumbar intervetebral disc protrusion. Complete exposure, release of adhesion,removal of disc and reasonable interal fixation of spine may lead to good surgical results.