小切口开窗式髓核摘除术治疗腰椎间盘突出症临床分析

【摘要】  目的：通过评价小切口开窗式髓核摘除术治疗腰椎间盘突出症的临床疗效，探讨该手术的优缺点及注意事项。方法：对62例腰椎间盘突出症患者采用小切口开窗式髓核摘除术治疗，手术前后根据日本骨科学会(JOA)下腰痛评分标准评分，评价手术效果。结果：62例患者均获随访，时间0.5～2年，平均1.2年，JOA评分优良率91.9%，平均改善率69.4%，手术前后JOA评分比较差异有显著性(P＜0.05)。结论：小切口开窗式髓核摘除术治疗腰椎间盘突出症疗效肯定，对腰椎生理结构破坏较小，发生术后腰椎不稳及腰椎术后失败的可能性低。

【关键词】  腰椎间盘突出症 外科手术 微创性

　Abstract  Objective:To evaluate clinical efficacy of small incision windowed discectomy for lumbar disc herniation and explore the clinical advantages and disadvantages of surgical and precautions.Methods:62 patients with lumbar disc herniation were treated with a small incision windowed discectomy treatment,before and after surgery,according to the Japan Orthopedic Association(JOA) scoring criteria of low back pain score,evaluation of results of operations was done.Results:62 patients were followed up for 6 months to 2 years,an average of 1.2 years,JOA score was an excellent rate of 91.9% and with an average improvement rate of 69.4%.The difference before and after surgery JOA score was significant(P＜0.05).Conclusion:small incision windowed discectomy in the treatment of lumbar disc herniation was physiological well;less damage occurred after lumbar spine surgery;lumbar spine instability and the possibility of failure was low.

　　Key words  Lumbar disc herniation;surgery;minimally invasive

　　资料与方法

    2006～2008年我院开展小切口开窗式髓核摘除术治疗腰椎间盘突出症患者62例，男40例，女22例；年龄20～61岁，平均41岁；病程6个月～15年，平均3.6年；L3～4 5例，L4～5 32例，L5～S1 25例；椎间盘中央突出34例，左侧突出16例，右侧突出12例；32例CT/MRI提示神经根管狭窄。所有入选病例符合下列标准：均有较典型的临床症状、体征，影像学与临床诊断为单节段腰椎间盘突出者，神经定位体征均与影像学定位单节段突出相符合，经保守治疗至少6个月后症状无明显缓解。

    手术方法：34例行中央开窗手术，16例行左侧开窗手术，12例行右侧开窗手术。患者均采用硬膜外麻醉，俯卧于手术托架上，腹部悬空，尽量使椎板间隙张开，采用术前、术中定位相结合的方法，以体表及术中C形臂X线定位。定位后取后正中纵向切口，长2.5～4cm。手术入路为：椎间盘侧方突出采用单侧开窗，中央突出采用中央开窗，用Cobb骨膜剥离其沿一侧棘突及椎板行骨膜下剥离，直角椎板拉钩牵开椎旁肌，暴露病变椎间隙、上下部分椎板和关节突关节。再次确定病变部位，用椎板咬骨钳咬去部分椎板，约1.5cm×1.5cm的骨窗，用神经剥离器游离黄韧带的上、下及外缘，切除黄韧带，分离粘连，在棉片保护下牵开神经根，显露突出椎间盘，

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