小切口单侧椎板开窗椎间盘摘除联合侧隐窝扩大术在老年患者中的应用  

Application of Small Incision Unilateral Finite Vertebral Fenestration for Intervertebral Disk Extirpation Combined with Lateral Recess Enlargement Technique In Aged Patients

作　　者：朱成明[1] 张德明[1] 姚文华[1] 王贵富[2] 

机构地区：[1]雅安市人民医院神经外科,四川雅安625000 [2]遵义医学院脑外科

出　　处：《华西医学》2012年第11期1629-1633,共5页West China Medical Journal

摘　　要：目的探讨老年人腰椎间盘突出合并侧隐窝狭窄症的临床特点及手术方式,总结和介绍小切口单侧椎板开窗椎间盘摘除联合侧隐窝扩大术的优点和可行性。方法 2006年7月-2011年1月对76例患者行后正中切口4.0～6.0 cm,在C臂X线机定位下,保留棘上、棘间韧带和棘突,骨膜下剥离骶棘肌,显露椎板、椎板间隙和关节突起,在椎板间隙间开骨窗,切除关节突内侧小部分后,环形切除突出的纤维环取出髓核,扩大成形侧隐窝,解除所有卡压脊神经根组织,彻底松解脊神经根。结果术后76例随访15～24个月,平均18个月,均按中华脊柱外科学会脊柱学组腰腿痛手术评定标准评定:优63例,良10例,一般及差3例,优良率达96.05%。手术前后Oswestry功能障碍指数评分与腰痛及腿痛视觉模拟评分法评分比较,差异有统计学意义(P<0.05)。结论小切口单侧椎板开窗椎间盘摘除联合侧隐窝扩大术,是一种手术创伤小,能在直视下操作,避免手术失误,彻底去除神经根致压物,不仅能够扩大神经根管,而且可行侧隐窝的探查及松解,同时兼顾脊柱稳定结构基本不被破坏,疗效满意,尤其在老年人中值得推广。Objective To investigate the clinical characteristics and surgical treatments of lumbar disk herniation with lateral recess stenosis in aged patients,and summarize the advantage and feasibility of small incision unilateral finite vertebral fenestration for intervertebral disk extirpation combined with lateral recess enlargement technique.Methods Between July 2006 and January 2011,after taking a midline incision of 4.0 – 6.0 cm,with C-arm machine positioning, the surgery retained the ligamentum supraspinale,ligamentum interspinales,and processus spinosus,and dissected the sacrospinalis under the periosteum to reveal the lamina of vertebra,interspace,and articular process.Fenestration was performed between the interspace.Half vertebral lamina and inside part of intervertebral joints were excised.The nucleus pulposus was taken out after the excision of fibrous ring.After the lateral recess was expanded,we decompressed and explored the spinal nerve roots.Results Seventy-six patients were followed up for 15 to 24 months,averaging 18 months. The operation evaluation criteria of lumbago and leg pain of Chinese Medical Association Spine Group were taken to evaluate therapeutic effect.The result was excellent in 63 cases,good in 10,and no effect in 3,with the excellent and good rate being 96.05%.ODI scores and leg pain VAS scores before and after surgery were significantly different（P 0.05）. Conclusions Small incision unilateral finite vertebral fenestration for intervertebral disk extirpation combined with lateral recess enlargement technique has the advantage of small trauma,exposure operation clearness,low rate of wrong operation, which is especially safe and effective for aged patients.

关 键 词：腰椎间盘突出症 侧隐窝狭窄 小切口 开窗法 老年人 

分 类 号：R687.3[医药卫生—骨科学]