腰椎间盘突出症手术适应证的选择

Selection of the surgical indication of lumbar disc herniation

目的 探讨影像学检查和手术方法对腰椎间盘突出症手术适应证的影响。方法 为 6 0例腰椎间盘患者实施微创开放式手术 ,术中用C臂X线机定位 ,做 3～ 3 5cm长的皮肤切口 ,剥离椎间的部分骶棘肌 ,咬除部分椎板上缘及小关节内侧缘后摘除髓核 ,并根据需要扩大神经根管。结果 术后随访 2～ 2 1(平均 11 5 )个月 ,按Nakai标准评定疗效 :优 4 5例 (75 % ) ,良 12例 (2 0 % ) ,可 2例(3 3% ) ,差 1例 (1 7% )。结论 影像学检查在腰椎间盘突出症手术适应证的选择上起重要作用。手术方法的改进 ,使创伤减小、手术适应证相对放宽 。

Objective To investigate the effect of radiograph and method of operation on the surgical indication of lumbar disc herniation. Methods 60 cases of lumbar disc herniation were operated by the method of minimal invasive open operation. The nucleus was resected through an incision of 3～3 5 cm in length under the guidance of the C arm. The sacrospinalis muscle between laminaes was stripped partly and the part of upper lamina and the part of medial facet was resected. The herniated disc was removed and the nerve root canal was decompressed if necessary. Results All cases were followed up from 2 months to 21 months, with an average of 11 5 months. According to the Nakai scale, The results were excellent in 45 cases(75%), good in 12(20%), fair in 2(3 3%) and poor in 1(1 7%). Conclusion Radiograph is very important for suitable selection of surgical indication of lumbar disc herniation. Less trauma, wider indication and more satisfactory outcome could be attained with the improved operative method.