有限手术治疗多节段腰椎间盘突出症

目的探讨多节段腰椎间盘突出症的临床诊断要点及有限手术治疗多节段腰椎间盘突出症的临床疗效。方法回顾分析我院2000年3月～2007年5月共用多节段开窗加神经根管减压的有限手术治疗多节段腰椎间盘突出症124例,全部病例术前均行X线片、CT或MRI检查报告腰椎间盘多节段突出,临床体征与影像学报告相一致。术后平均5.6年经腰椎X线动力位片判定脊柱的稳定性,疗效按NAKAI标准进行术前、术后对比。结果124例均获随访8个月～7年,平均5.6年,疗效评定为：优68例、良37例、可17例、差2例,总优良率达84.7%。所有病例除有1例并发腰椎间盘突出症复发及2例并发椎间隙感染外,其余均无近期严重并发症出现,也无腰椎失稳现象发生。结论多节段开窗的有限手术能在直视下切除椎间盘,彻底地松解神经根并维持脊柱的稳定性,最大程度地减少并发症的发生,是治疗多节段腰椎间盘突出症的有效和可靠方法。

Limited operative treatment for multisegmental lumbar disc herniation

Objective To explore the clinical diagnosis of muhisegmental lumbar disc herniationand the clinical effect of limited operative treatment for multisegmental lumbar disc herniation. Methods To retrospectively analyze clinical data of 124 cases with multisegmental lumbar disc herniation treated by limited operation of multiple segmental fenestration plus foraminal stenosis decompression in our hospital during March 2000- May 2007. All the cases were diagnosed as muhisegmental lumbar disc herniation by X-ray, CT or MRI before operation,whose clinical signs were accordant with radlologic findings . The stability of spinal was assessed by lumbar dynamics position X-ray film averaged 5.6 years after operation. The clinical assessment before and after the therapy was based on NAKAI standard. Results All 124 cases were followed up for 8 months-7 years, a mean time of 5.6 years. The results were excellent in 68 cases, good in 37, fair in 17 and poor in 2, the overall excellent and good rate was 84.7%. There were no severe complications and lumbar unsteadiness except I case with recurrence and 2 cases with intervertebral space infection. Conclusions The limited operative treatment of multiple segmental fenestration could excise disc by euthy- phoria, relax the nerve root completely, maintain the stability of spinal, and maximize the decrease of complications. So it was one of effective and reliable treatments for multisegmental lumbar disc herniation.