五种特殊类型腰椎间盘突出症的临床分析

The clinical analysis of five specific types of lumber disc herniation

目的探讨五种特殊类型腰椎间盘突出症的临床特点、手术方式及疗效。方法总结2006年1月～2011年1月5年间住院治疗的32例特殊类型腰椎间盘突出症的临床资料。结果极外侧型突出6例，神经根袖内突出2例，硬脊膜囊内突出5例，后纵韧带前后游离型突出8例，突出钙化或形成骨软骨结节11例。其中行单纯腰椎间盘摘除26例，腰椎间盘摘除＋椎间融合和后路短节段椎弓根钉棒系统内固定6例，手术疗效优24例，良8例，差0例，效果满意。结论五种特殊类型腰椎间盘突出症中，极外侧型和神经根袖突出型较为隐匿，易于漏诊；硬脊膜囊内突出、游离型突出和钙化型突出手术易于遗漏或残留椎间盘组织，导致疗效不佳或手术失败。病史、体查、影像学资料结合术中细致的探查是保证手术成功的关键。

Objective To investigate the clinical characteristics,surgical methods and effect of five specific types of lumbar disc herniation. Methods To summarize the clinical data of 32 inpatients with specific type of lumber disc herniation from January 2006 to January 2011. Results during these cases, there are 6 cases with extreme lateral type,2 cases with medial nerve root sleeve type ,5 cases with inside the dural sac type ,8 cases with the free before or after the posterior longitudinal ligament type, 11 cases with calcification or Osteochondral node type. There are 26 cases undergoing simple lumbar discecto- my,6 cases undergoing lumbar discectomy and interbody fusion and short - segment fixation with posterior pedicle screw and rod system,we were satisfactory with the results for 24 cases bing excellent,for 8 cases bing good,for 0 case bing poor. Condusion For these five specific types of lumbar disc herniation, the extreme lateral type is hidden and easy to fail to diagnose; for inside the dural sac type, the free before or after Posterior longitudinal ligament type and the calcification type ？there are easy to have omission or residual disc tissue, and lead to poor efficacy or surgery fail. History, physical examination, combined with imaging data and detailed intraoperative exploration is the key to ensure successful operation.