椎间孔及椎间孔外腰椎间盘突出症的手术治疗

目的 比较三种没术式在椎间孔及椎间孔外腰椎间盘突出症治疗中的优、缺点，探讨各自的最佳适应证。方法对本院１９９２年８月－１９９８年４月间手术治疗的３４例椎间孔及椎间孔外腰椎间盘突出症病例进行随访，了解其术后症状改善情况，并同时摄Ｘ线片观察手术对局部稳定性的影响，平均随访２９个月。结果 经峡部外缘入路手术１９例，手术时间平均６２分钟，平均出血量５８ｍｌ，手术总优良率９３％。经椎板、峡部关节突切除途径５

Surgical Treatment of the Foraminal and Extraforaminal Lumbar Disc Herniations

Objective To compare advantages and disadvantages treatment of the foraminal and extraforaminal lumbar disc herniation, the clinical effects and surgical indicaction of the three different surgical approaches. Methods 34 cases with foraminal or extraforaminal lumbar disc herniations were treated surgically, 19 had undergone the operation by the approach of outer edge of par interarticularis, 10 by laminectomy, 5 by complete unilateral facetectomy and unilateral hemilaminectomy. The follow up examinations were performed by questionnaire and X-ray of lumbar spine. Results In the group approached from the outer edge of par interarticularis, the average operation time was 62 minutes. The average amount of blood loss was 58 ml, and the excellent and good rate was 93%. The operation time of the laminectomy group and the unilateral facetectomy group were 118 and 106 minutes, and the amount of blood loss were 368 ml and 210 ml respectively. Decreased intervertebral height and segmental instability were found in 2 out of 5 cases underwent complete unilateral facetectomy and unilateral partial hemilaminectomy. Conclusion The approach of outer edge of par interarticularis had the advantage of good exposure, less blood loss and less affect to lumbar stability. The method could be applied in most of cases with L 3,4 and L 4,5 foraminal or extraforaminal lumbar disc herniations. If the combined posterior lateral disc herniation was the main pathologic change, laminectomy approach may be used. The approach of complete unilateral facetomy and unilateral partial hemilaminectomy, could be used for the cases with L 5S 1 foraminal or extraforaminal lumbar disc herniation.