高位腰椎间盘突出症的手术治疗方法选择

Selection of surgical treatment for upper lumbar herniation

目的探讨不同节段高位腰椎间盘突出症采用不同手术方法治疗的操作技巧与临床效果。方法回顾性分析自2013-07—2016-07诊治的43例高位腰椎间盘突出症,L_(1、2)椎间盘突出5例(L_(1、2)组),L_(2、3)椎间盘突出15例(L_(2、3)组),L_(3、4)椎间盘突出23例(L_(3、4)组)。L_(1、2)组及L_(2、3)组采用改良经椎间孔入路减压融合内固定治疗,L_(3、4)组采用改良经椎板入路减压融合内固定治疗。比较3组术前、术后3个月、术后1年ODI指数。末次随访时采用Prolo评分标准评定疗效。结果 43例均获得1年以上随访,随访时间平均16.3个月。3组术后3个月ODI指数较术前明显降低,且末次随访时ODI指数较术后3个月明显降低,差异有统计学意义(P<0.05)。末次随访时采用Prolo评分标准评定疗效:L_(1、2)组优4例,良1例;L_(2、3)组优8例,良6例,可1例;L_(3、4)组优12例,良8例,可3例。结论 L_(1、2)及L_(2、3)椎间盘突出症可采用改良经椎间孔入路减压融合内固定治疗,而L_(3、4)椎间盘突出症可采用改良经椎板入路减压融合内固定治疗,术后可取得满意的临床疗效。

Objective To investigate operative skill and efficacy for upper lumbar herniation according to lesion segment.Methods A retrospective study of 43 patients with upper lumbar herniation treated from July 2013 to July 2016 was conducted. The number of disc herniation patients at L（1、2）, L（2、3）, L（3、4） were 5, 15, 23 respectively. Patients with L（1、2） or L（2、3） upper lumbar herniation underwent modified transforminal lumbar interbody fusion（TLIF） while patients with L（3、4） upper lumbar herniation underwent modified posterior lumbar interbody fusion（PLIF）. ODI before operation and 3 months and 1 year after operation was measured and compared in the three groups. The surgical outcomes were assessed by using the Prolo functional economic outcome rating scale at last follow-up. Results All the patients were followed up for more than 1 year. The mean followed up were 16.3 months. ODI at 3 months postoperatively compared to that before operation and ODI at last follow-up compared to 3 months postoperatively was decreased significantly in the three groups（P 0.05）. Outcomes with Prolo functional economic outcome rating scale at last follow-up were excellent in 4 cases and good in 1 case of group L（1、2）,excellent in 8 cases, good in 6 cases and fair in 1 case of group L（2、3）, excellent in 12 cases, good in 8 cases and fair in 3 cases of group L（3、4）. Conclusion For upper lumbar herniation, modified TLIF for L（1、2）, L（2、3） and modified PLIF at L（3、4） can achieve satisfactory effect.