手术治疗高位腰椎间盘突出症45例分析

Clinical Analysis of 45 Cases Treated by Open Operation for Upper Lumbar Disc Herniation

目的探讨高位腰椎间盘突出症的临床特点及手术方式的选择。方法回顾分析发生于L1-L4间盘突出45例，患者腰痛或腿疼症状严重，术前行x线（45例）、CT（45例）或MRI（28例）检查，分别行后路单纯椎板切除（16例）、椎板开窗（L4）和／或扩大开窗（L2-3）（共17例）、榷板加小关节切除椎间孔入路（L1—2）（9例）和前外侧入路（3例）髓核摘除术，其中25例同时行椎间、横突或对侧关节突植骨融合内固定术。结果全部获随访．时间2—6年。术中硬脑膜破裂脑脊液漏2例。疗效评价参照日本腰腿病疗效评定标准评价疗效：优38例，良6例，差1例，优良率为978％．结论高位腰椎间盘突出症的临床表现复杂，根据突出的部位和影像学结果不同而采取不同手术方法。

Objective To analyse the clinical characteristics and methods treatment of the upper lumbar disc herniation. Methods 45 patients of upper lumbar disc herniation with severe low back and leg pain were undergone X-ray （45 cases）,CT （45 cases）,MRI （28 cases） examination before surgery operation,and treated by posterior approach vertebrate lamina resection（16 cases）,open window（LI-2） and/or enlarged open window（L2-3）（17 cases） , vertebrate lamina resection and small articular resection （L1-2）（9 cases） and lateroanterior approach disc resction （3 cases） and 25 cases in these 45 cases were treated with transverse process,contralateral interarticular process and vertebral lamina bone grafting and internal fixation meanwhile.Results All patients were followed up for 2-6 years and 2 cases with leakage of cerebrospinal fluid.According to the evaluation system of Japanese Orthopaedic Association Seorces for Assessment of Lower Lumbar Pain （JOA）, the results were excellent in 38 cases, good in 6,and fair in 2, and the excellent and good rate was 97.8%.Conclusions The clinical manifestations of upper lumbar disc herniation are complicated.The approach of operation should be determined by the site of upper lumbar vertebrae anatomy and the results of radiography of herniation discs.