通道下单侧椎板入路双侧减压治疗腰椎间盘突出并对侧下肢症状  

Unilateral Approach Bilateral Decompression for Lumbar Disc Herniation With Contralateral Symptoms

作　　者：高飞[1] 段洪凯[1] 王洪伟[1] 宋志会 李铭章[1] 姜鑫 Gao Fei;Duan Hongkai;Wang Hongwei(Department of Orthopedics, Dongguan Tungwah Hospital, Dongguan 523110, China)

机构地区：[1]广东省东莞东华医院骨科,东莞523110

出　　处：《中国微创外科杂志》2022年第1期69-73,共5页Chinese Journal of Minimally Invasive Surgery

摘　　要：目的探讨通道下单侧椎板入路双侧减压治疗腰椎间盘突出并对侧下肢症状的疗效。方法回顾性分析2010年1月~2020年12月11例以一侧腰椎间盘突出并对侧下肢为主要症状者的手术疗效,均为单间隙旁中央型髓核突出。均由髓核突出侧行单侧椎板开窗髓核切除术,5例行对侧神经根减压,6例椎间盘摘除后仍有明显后纵韧带隆起,硬膜囊挤压,行经椎间孔椎间融合内固定(transforaminal lumbar internal fixation,TLIF)。结果术中所见突出髓核与影像学相吻合,突出侧神经根无炎性水肿、粘连,对侧无髓核突出,3例侧隐窝狭窄,2例黄韧带肥厚及神经根水肿粘连,6例后纵韧带隆起推挤硬膜囊造成神经根张力高、活动度差。术后对侧下肢症状均缓解。11例随访6~25个月,中位数16.2月,改良MacNab标准,优良率91%(10/11)。结论由髓核突出侧入路行双侧椎管减压,对脊柱结构破坏少,减压充分,避免对侧症状残留,手术效果良好。Objective To investigate the effect of unilateral approach bilateral decompression for lumbar disc herniation(LDH)with contralateral symptoms.Methods A retrospective analysis was made on 11 LDH cases with predominantly contralateral neurologic deficits from January 2010 to December 2020.All the cases were single parainterstitial central nucleus pulposus protrusion.Unilateral laminectomy was performed on the protruding side of nucleus pulposus.Contralateral nerve root decompression was performed in 5 cases.Obvious protrusion of posterior longitudinal ligament and extrusion of dural sac were found in 6 cases after discectomy,and transforaminal lumbar internal fixation(TLIF)was further performed.Results The protruding nucleus pulposus in operation was consistent with the imaging.There was no inflammatory edema or adhesion of the nerve root on the protruding side,and no protrusion of the nucleus pulposus on the opposite side.Lateral recess stenosis was found in 3 cases.Hypertrophy of ligamentum flavum and edema and adhesion of nerve root was found in 2 cases.High tension and poor activity of nerve root caused by the protrusion of the posterior longitudinal ligament was found in 6 cases.The symptoms of the contralateral lower limbs were relieved after operations.All the 11 cases were followed up for 6-25 months,with a median of 16.2 months.The excellent and good rate of the modified MacNab criteria was 91%(10/11).Conclusion Bilateral spinal canal decompression through the lateral approach of nucleus pulposus protrusion has advantages of less damage to the spinal structure,sufficient decompression,avoiding the residue of contralateral symptoms,and good surgical effect.

关 键 词：椎间盘突出 对侧 椎间盘切除术 

分 类 号：R68[医药卫生—骨科学]