极外型腰椎间盘突出症的诊断和改良术式治疗经验体会(附8例报告)

Diagnosis and Treatment of Far Lateral Disc Herniation with Modified Operative Procedures (A Report of 8 Cases)

目的 探讨极外型腰椎间盘突出症较为合理的手术方式 ,总结复习 8例病人的临床特点、影像学资料和手术方式及治疗效果。 方法 5例行关节突外侧开窗式椎间盘摘除术 ,3例合并有侧隐窝狭窄行关节突内侧部分切除减压加关节突外侧开窗椎间盘摘除术。 结果 术后随访未见复发和腰椎不稳 ,优 4例 ,良 4例。 结论 对于单纯的极外型椎间盘突出 ,采用小关节突外侧开窗 ,术中只切除少量的关节突和椎板峡部骨质 ;对合并有侧隐窝狭窄或椎管内椎间盘突出者 ,采用小关节内侧部分切除 ,加小关节外侧开窗椎间盘摘除术式 ,保留部分关节突和椎板峡部。这两种术式均既处理了病灶 ,又最大限度地保留了骨性结构 。

Objective To find more effective surgical procedures for lumbar disc herniation, we summarized and reviewd the clinical findings,radiological data,operative procedures and curative effect of 8 cases.[WT5”HZ] Methods [WT5”BZ]In 5 cases lateral fenestration was conducted at the joint for lumbar disc herniation excision. For the 3 cases complicated by narrow lateral recess, medial facetectomy was performed at the joint for decompression and lumbar disc herniation excision. Results No recurrence and lumbar spinal instability were found, we have got satisfactory effect of four and the other were good. [WT5”HZ] Conclusion [WT5”BZ]Lateral fenestration is more effective for simple lateral lumbar disc herniation than other procedures,because it only involves a small ablation of the joint processus and bone of the vertebra isthmus.To the patients who are complicated by lateral recess stenosis and lumbar disc herniation in the vertebra canal,the procedure of lateral recess decompresson with medial facetectomy and lateral fenestration is appropriat because it retains parts of the joint processus and bone of the vertebra isthmus.The two methods not only treat the focus but also retains the osteal structure. They play a positive role in preventing spinal instability and low back pain.