腰椎间盘突出并椎体后缘离断症的手术治疗  

Surgical treatment of lumbar intervertebral disc herniation complicated with posterior element distraction

作　　者：黄民锋[1] 李明[1] 陈锋[1] 许建文[2] 李寿斌[1] 贾经汉[1] 邹冬青[1] 袁振超[1] 

机构地区：[1]广西中医学院附属瑞康医院骨腰骶科,南宁市华东路10号530011 [2]广西中医学院第一附属医院骨科,南宁市园湖路2号530023

出　　处：《中国脊柱脊髓杂志》2007年第8期596-599,共4页Chinese Journal of Spine and Spinal Cord

摘　　要：目的:探讨腰椎间盘突出并椎体后缘离断症的手术治疗效果。方法:对1997年6月至2006年5月收治的51例腰椎间盘突出并椎体后缘离断症患者的临床资料进行回顾性分析。无明显侧隐窝狭窄且离断骨块较小者17例,采用开窗、半椎板切除摘除骨块与髓核;伴有明显侧隐窝狭窄者10例,在扩大开窗、摘除骨块与髓核的同时切除关节突内缘、扩大神经根管;中央型或旁中央型者(或部分合并有椎管狭窄者)21例,采用双侧开窗切除突出椎间盘和离断骨块;离断骨块较大、累及椎管前方大部分或黄韧带增厚伴明显椎管狭窄者3例,采用全椎板切除骨块与髓核、椎弓根螺钉内固定及后外侧植骨融合术(PLF)。应用JOA评分及改善率评价治疗效果。结果:随访6个月-9年6个月,平均3年6个月。术前JOA评分平均4.48分,末次随访时平均14.5分,改善率为95.2%;优良率为94.1%。3例伴有马尾神经损伤患者,末次随访时症状大部分消失;其中1例有排尿排便障碍患者,大小便功能明显改善。行PLF的3例患者X线检查显示植骨融合率100%,融合节段稳定。结论:对腰椎间盘突出并椎体后缘离断症患者采用相应的手术方式,摘除突出椎间盘及后缘骨块,彻底解除突出物对神经根和马尾神经的压迫,可取得较好效果。Objective：To evaluate the surgical treatment of lumbar intervertebral disc herniation complicated with posterior element distraction.Method：A total of 51 patients with lumbar intervertebral disc herniation complicated with posterior element distraction undergoing surgery from June 1997 to May 2006 were reviewed retrospectively.Of these,17 cases with no lateral recess narrowing and small bony distraction were treated with semi-laminectomy,osteoectomy and nucleus pulpsus excision.10 cases with severe lateral recess stenosis were treated with semi-laminectomy,facet excision and nerve root canal decompression.21 cases with central protrusion of nucleus pulpsus paramiddle（or canal stenosis） were treated with bilateral laminectomy,osteoctomy and disc excision.3 cases with large bony distraction and spinal canal stenosis were treated with laminectomy,distraction excision and posterior lumbar interbody fusion.Each patients＇ pre and postoperational status was evaluated based on the Japanese Orthopedic Association （JOA） functional scales.Result：Follow-up period ranged from 6 months to 9.5 years （mean,3.5 years）.The mean JOA scores of all cases were 4.48 before operation and 14.5 after operation respectively.3 cases with cauda equina defecit and 1 case with dysporia improved after operation.3 patients undergoing posterior lumbar interbody fusion had bony fusion at final follow-up.Conclusion：Decompression of nerve root canal and spinal canal is effective in dealing with lumbar intervertebral disc herniation complicated with posterior element distraction.

关 键 词：椎体后缘离断症 腰椎间盘突出症 手术治疗 

分 类 号：R681.5[医药卫生—骨科学]