经椎小关节入路手术治疗复发性腰椎间盘突出症  

Articular Processus Fenestration of the Surgical Approach for Treatment of Recurrent Lumbar Disc Herniation

作　　者：李义强 何国雄 钟小兵 李文锐 

机构地区：[1]广东省韶关市第一人民医院骨科,广东韶关512000

出　　处：《实用骨科杂志》2011年第4期307-309,共3页Journal of Practical Orthopaedics

摘　　要：目的介绍经椎小关节入路手术治疗复发性腰椎间盘突出症的手术方法。方法采用后正中切口显露相应节段患侧的椎小关节,切除上一椎骨的下关节突,显露下一椎骨的上关节突关节面,再切除下一椎骨上关节突的内1/2进入椎管,切除残存的黄韧带,显露硬脊膜和神经根,松解黏连,扩大神经根管并切除膨出的纤维环,摘除髓核,与硬脊膜及神经根黏连的瘢痕组织不作切除。结果从2002—2009年采用此方法手术治疗复发性腰椎间盘突出症64例,经平均4.2年随访,全部病例均获得满意疗效。结论经椎小关节入路这种方法解剖清楚,操作方便,显露充分,创伤小,出血少,手术时间短。无一例出现硬膜撕裂、神经损伤等手术并发症。Objective To introduce the operative method of unilateral articular processus fenestration for treatment of recurrent lumbar disc herniation.Methods The operation was performed processus approach.The inferior articular processus of upper vertebra was resected,so the facet of superior articular processus of lower vertebra was exposed and making the osteotomy once again.Resecting the superior articular processus of lower vertebra and remaining yellow ligament,the dural sac and nerve root.At the same time the adhesions was released.The nerve roots orifices were enlarged,then pushing aside the nerve root to resect the lumbar disc.The scar tissue was left alone.Results From 2002 to 2009 year,there were 64 cases of recurrent lumbar disc herniation treated by this way.The follow-up period lasted in an average of 4.2 years.All of the patients achieved a satisfactory effect.Conclusion The main advantages of this way was exposed very cleary,technically simple,less tissue damage,less hemorrhage,and shorter operative time.Complocations such as leakage of cerebrospinal fluid,neurologic injury were not observed.

关 键 词：复发性腰椎间盘突出症 手术治疗 椎小关节 

分 类 号：R681.53[医药卫生—骨科学]