高位腰椎间盘突出症后路手术治疗探讨

Discussion of Post Operative Management of the Upper Lumbar Disc Hernisyion

目的：观察通过后路行椎板及关节突切除减压并经椎间孔行椎间盘切除椎间植骨椎弓根螺钉内闹定治疗高位腰椎间盘突出症的临床疗效。方法：2004年4月~2010年6月我院共收治且获得随访的单间隙高位腰椎间盘突出症患者共32例,其中L1/2 12例,L2/3 10例,L3/410例。均接受经椎问孔椎间盘切除椎间植骨椎弓根螺钉内固定术治疗,其中26例行单侧椎板切除减压、6例行全椎板切除减压术。术前、术后1年随访时进行疼痛视觉模拟评分（VAS）、Oswestry功能障碍指数（ODl）评估和椎间隙相对高度（R）测量,观察植骨融合情况。结果：手术时间100~160分钟,平均112.6分钟,术中出血180~320ml,平均248ml。术中无硬膜损伤。1例术后出现对侧神经根牵拉伤,经对症处理后症状消失。均获得1年以上随访。术前VAS、ODI及R分别为8.5±0.5分、52.22±9.27%、0.19±0.054、术后1年时VAS、ODI及R分别为1.9±0.7分、19.28±5.34%、0.315±0.049,较术前均有明显改善（P〈0.05）。1例可能不融合,融合率为97%;内置物位置佳,无松动、脱出。结论：采用后路行椎板及关节突切除减压并经椎间孔行椎间盘切除椎间植骨椎弓根螺钉内固定治疗高位腰椎间盘突出症可获得较满意疗效。

Objective： To investigate post operative management of the upper Lumbar disc hernisyion.Method：32 cases with upper lumbar disc herniation undergoing laminectomy,transforamina discectomy and lumbar interbody fusion（26cases with partial laminectomy,6cases with total laminectomy） in our hospital from Apr 2004 to Jun 2010 were reviewed retrospectively,the involved level included L1/2 in 12 cases,L2/3 in l0 cases and L3/4 in 10 cases.Oswestry score was used to evaluate the neurological status,VAS score and Mochida,s score were used to assess low back pain and the intervertebrai space height respectively before operation and 1 year after operation.Schulte method was used to evaluate the fusion status I year after operation.Result： The average operation time was 112.6 minutes,the average intraoperative blood loss was 248 ml and no spinal dura mater injury was noted,l patients was complicated with contralateral nerve root stretch injury,which was resolved after conservative treatment All the paeient were followed up for more than one year.The preoperative VAS,ODI and R value were 8.5±0.5,（52.22±9.27） %,0.19±0.054,respectively,which showed significant improvement,and bony union rate was noted as 99% except 1case of uncertain.No implant failure was found.Conclusion：Laminectomy with transforaminal discectomy and lumbar interbody fusion for upper lumbar disc herniation is reliable and effective.