手术治疗腰椎间盘突出合并椎管狭窄症

Surgical Treatment of Lumbar Intervertegral Disc Prolapse Associated with Narrow Vertebral Pipe Syndrome

目的 :探讨保留棘上韧带全椎板切除行髓核摘除术治疗腰椎间盘突出合并椎管狭窄症的疗效与优越性。方法 :治疗组用保留棘上韧带全椎板切除行髓核摘除术 ;对照组为半椎板切除行髓核摘除术 ,术后第 5d治疗组开始腰背肌锻炼。 2组均随访 1至 15年。结果 :治疗组手术优良率与治愈率均高于对照组 ,2组比较差异有显著性 (P <0 .0 5 )。结论 :侧卧位保留棘上韧带全椎板切除行髓核摘除术能在视野显示良好的条件下直视判别病理改变情况 ,能充分扩大减压 ,减少术中出血 ,缩短手术时间 ,提高手术治疗效果 ,防止并发症发生 ,但要掌握手术适应症和术前术后腰背肌功能锻炼的必要性及注意事项。

Objective: To explore the curative effect and the advantages of whole laminectomy and marrow core excision while keeping upper spinous ligament for lumbar intervertegral disc prolapse associated with narrow vertebral pipe syndrome. Methods: The treatment group was treated with whole maminectomy and marrow core excision while keeping upper spinous ligament. The control group was treated with half laminectomy and narrow core excision. All the patients were followed up after operation for 1 to 15 years. Results: The operative effective rate in the treatment group was higher than in the control group ( P < 0.05 ). Conclusion: For whole laminectomy and marrow core excision while keeping upper spinous ligament in lying position, pathological changes can be differentiated directly in good visual condition, pressure can be fully reduced, less bleeding can be achieved, operation time can be shortened, operative curative effect can be improved and complications can be prevented. However, operative indications must be well controlled, the necessity and points for attention of excising lumbar muscle function before and after operation must be fully advised to pateints.