6815例腰椎间盘突出症的手术治疗

目的：探讨腰椎间盘突出症的手术治疗方法。方法：采用脊神经后支阻滞麻醉屈曲位经椎板间隙侧方入路椎间盘摘除术，双开窗扩大减压治疗中央宽基底型椎间盘突出钙化，小切口开窗潜行减压髓核摘除术等三种方法共治疗腰椎间盘突出症6815例。结果：6815例患者中5324例经过半年至14年（平均6．3年）随访，优4260例（80．02％），良855例（16．06％），进步209例（3．92％），优良率达96．08％。随访中X线检查显示手术后相应椎间隙不同程度的变窄，未见腰椎失稳和腰椎滑脱。结论：采用的三种方法与传统术式比较创伤小，可最大限度地保留腰椎后部结构的完整性，且手术时间短，康复快。

Surgical therapy of lumbar disk herniation in 6 815 cases]

OBJECTIVE: To explore the surgical therapy for lumbar disc herniation (LDH). METHODS: Under local anesthesia by blocking the posterior branches of spinal nerves, 3 surgical approaches were adopted in 6 815 LDH cases, namely discectomy by lateral and interlamina access, double fenestration and enhanced decompression for broad central LDH, and removal of nucleus pulposus with small incision and fenestration. RESULTS: Follow-up study was conducted in 5 324 cases for the duration varying from 6 months to 14 years, averaging 6.3 years. Excellent results were achieved in 4 260 cases (80.02%), good in 855 cases (16.06%) with another 209 cases (3.92%) showing symptomatic improvement. X-ray examination in these cases revealed narrowed intervertebral spaces of different degrees without lumbar instability or spondylolisthesis. CONCLUSION: In comparison with conventional approaches, the 3 surgical approaches for LDH management may preserve the utmost integrity of the posterior lumbar structures and cause less traumatic injuries with shortened operation time and quick recovery.