腰椎间盘突出症手术疗效分析

目的探讨腰椎间盘突出症患者行髓核摘除术的手术方式及治疗效果。方法对我院2002～2010年214例行髓核摘除术的腰椎间盘突出症患者的临床资料进行回顾性分析,行开窗髓核摘除137例,半椎板切除髓核摘除49例,全椎板切除髓核摘除28例,其中18例予以椎弓根钉内固定植骨融合。结果本组214例行手术治疗,均获成功,平均手术时间（90.0±12.5）min,平均失血量（50.2±21.2）mL,平均住院（17.8±9.2）d。术后并发脑脊液漏3例,椎间隙感染2例,均经对症治疗后好转,所有患者均顺利出院。本组214例患者中148例术后获随访,平均随访时间2.8年,按Nakai评定标准,优84例（56.8%）,良50例（33.8%）,可10例（6.8%）,差4例（2.7%）,优良率为90.5%。结论髓核摘除术治疗腰椎间盘突出症的远期疗效确切,严格掌握手术适应证、术式的选择、术后并发症的治疗及术后康复训练是提高手术疗效的关键。

Clinical analysis of surgical effect of lumbar disc herniation

Objective To investigate the surgery method and the effect of the patients with lumbar disc herniation treated by discectomy.Methods Clinic data of 214 patients with lumbar disc herniation in our hospital from 2002 to 2010 were analyzed retrospectively,of which 137 cases were given discectomy window discectomy,49 cases were given semi-laminectomy discectomy,28 cases were given laminectomy discectomy,and 18 cases were given the pedicle screw fixation and fusion.Results 214 cases of patients were successful after surgery,the average operative time was(90.0±12.5) min,the average blood loss was(50.2±21.2) mL,the average length of stay was(17.8±9.2) d.Cerebrospinal fluid leakage was happened in 3 cases postoperative,disc space infection in 2 cases,and improved after symptomatic treatment,all patients were discharged.148 cases were followed for an average time of 2.8 years,according to Nakai assessment standards,84 cases(56.8%) were excellent,50 cases(33.8%) were good,10 cases(6.8%) were basic improvement and 4 cases(2.7%) were poor,excellent and good rate was 90.5%.Conclusion The long-term efficacy of discectomy for lumbar disc herniation is exact,the key to improve efficacy is to control surgical indications,surgical options,complications treatment and rehabilitation after surgery.