高位腰椎间盘突出症的手术选择

Choice of operative method on 112 patients with upper lumbar intervertebral disc herniation

目的探讨高位腰椎间盘突出症的临床特点及手术方法的选择。方法112例高位腰椎间盘突出症患者中27例行全椎板减压髓核摘除内固定，21例行半椎板减压髓核摘除，20例行双侧开窗髓核摘除，44例行单侧后路开窗髓核摘除。结果112例均获随访，随访时间6～48个月。术后神经症状有不同程度恢复，术中硬脊膜破裂脑脊液漏13例，无神经损伤加重病例。参考中华医学会骨科学分会脊柱组腰背痛手术评定标准：优93例，良16例，可3例，优良率为97．3％。结论高位腰椎间盘突出症手术入路的确定应根据每例患者的具体情况选择。对于年轻、单节段及旁侧型的椎间盘突出症患者选择单侧开窗或半椎板减压髓核摘除；对多间隙、中央型突出髓核大者选择双侧开窗或全椎板减压髓核摘除，对严重椎管狭窄或合并椎间不稳者加椎间融合内固定。

Objective To investigate the choice of operation methods and clinical features on patients with upper lumbar disc herniation. Methods All the 112 patients were treated by surgical treatment, laminectomy and internal fixation in 27 cases, semi-laminectomy in 21 cases, bilateral fenestration in 20 cases and unilateral fenestration in 44 cases. Results All the 112 patients were followed up for 6 -48 months. No nerve injury was found. The results were excellent in 93 cases, good in 16 cases, and fair in 3 cases. The excellent and good rate was 97.3%. Conclusion The clinical manifestations of upper lumber disc herniation are complicated. The methods of operation should be determined by different condition： For a young, single segment and the lateral disc herniation patients, choose the unilateral window or semi-laminectomy and discectomy; For multi-gap, the central nucleus pulposus large patients, choose bilateral fenestration or laminectomydecompression discectomy; For severe spinal stenosis or merge intervertebral instability patients, choose interhody fusion and internal fixation.