极外侧腰椎间盘突出症的临床分型和手术治疗(47例分析)

Clinical classification and surgical treatment of the far-lateral lumbar disc herniation

目的分析极外侧腰椎间盘突出症的临床特点和外科治疗方法。方法回顾性分析2007-09-2011-04收治的一组极外侧腰椎间盘突出症(47例)患者的临床特点、影像学分型和手术疗效。结果根据影像学表现将本组患者分为椎间孔内型(I型)、椎间孔内和椎间孔外型(II型)、椎间孔外型(III型)、同节段混合型(IV型)以及复杂型(V型),根据分型采用相应的外科手术入路治疗,经过平均2.6年随访,临床疗效优30例(64%)、良12例(26%)、可4例(8%)、差1例(2%)。结论极外侧腰椎间盘突出症发病率低,容易误诊和漏诊,常合并其他腰椎退变性疾病,开放式手术是安全和有效的治疗方法。

Objective To analyze the clinical classification and surgical treatment of the far-lateral lumbar disc herniation （FLLDH）. Methods 47 cases suffered from FLLDH were surgically treated from Aug 2007 to Aprial 2011 ,and retrospectively analyze the clinical characteristic,imaging classification,and outcome of surgical treatment. Results According to the disc herniation location and the complicated lumbar diseases, the FLLDH were divided into five types in our study：foraminal disc herniation（type I）,foraminal and extraforaminal disc herniation（type II）,extraforaminal disc herniation（type III）,one segmental combination（type IV）and complicated type（type V）. According to the clinical classification,the patients were treated with different surgery. The postoperative outcomes showed excellent in 30 cases（64%）,good in 12 c ases（26%）,fair in 4cases（8%）and poor in 1 case（2%）after mean 2.6 years follow-up. Conclusion The FLLDH has a low incidence rate and a high misdiagnostic rate, and is often associated with other lumbar degenerative diseases. The traditional open surgeries are also safe and effective.