经峡部外缘途径手术治疗椎间孔及椎间孔外腰椎间盘突出症

目的　探讨经峡部外缘途径手术治疗椎间孔及椎间孔外腰椎间盘突出症临床效果。方法　采用经峡部外缘途径治疗椎间孔及椎间孔外腰椎间盘突出症 17例 ,其中L3～ 4 5例 ,L4～ 511例 ,L5S1 例。结果　随访 7～ 4 8个月 ,平均11个月 ,优良率 94 .11% ,除 1例L5S1 外 ,均无腰椎不稳征象。结论　采用经峡部外缘入路手术具有显露清楚 ,出血少 ,不影响稳定性等优点 ,对L3～ 4 、L4～ 5的椎间孔及椎间孔外腰椎间盘突出者可采用此法。     

经峡部外缘入路行椎间孔或椎间孔外型腰椎间盘突出摘除术

近年来随着ＣＴ和ＭＲＩ影像技术的发展,腰椎间孔和椎间孔外型椎间盘突出症逐渐被重视起来。它是腰椎间盘脱出在椎弓根内外缘之间或外缘以外,压迫相应节段神经根而引起的一系列症状和体征,亦称之为极外侧腰椎间盘突出症。其临床表现、影像学特征及手术治疗方法与典型的腰椎间盘突出症都有不同。１　临床资料１－１　一般资料１９９６年２月～１９９８年２月经椎板峡部外缘手术入路切除椎间孔或椎间孔外型腰椎间盘突出症１６例,男性１１例,女性５例,年龄２１～５５岁,平均３９－８岁,有外伤史１２例。病程２～４６个月,平均２８－７…     

椎间孔镜手术治疗腰椎间盘突出症早期复发原因分析及治疗策略

目的 探讨椎间孔镜手术治疗腰椎间盘突出症早期复发的原因及治疗策略.方法 回顾性分析自2015-06-2019-06采用经椎间孔入路或经椎板间入路行椎间孔镜下髓核摘除术治疗的209例腰椎间盘突出症.结果 209例均顺利完成手术并获得完整随访,随访时间6～18个月,平均13.5个月.6例早期复发腰椎间盘突出症,L4、54例...     

横突间髓核摘除术治疗椎间孔外腰椎间盘突出症

横突间髓核摘除术治疗椎间孔外腰椎间盘突出症王全平李稔生张毅刘建朱锦宇腰椎间盘突出症基本上发生于腰椎管内，压迫神经根和马尾神经引起腰腿痛［１～３］。突出发生于椎间孔外实属罕见，我们收治２例，占我科手术治疗２２４２例的０．１％。我们设计后路横突间髓核摘除...     

经椎间孔腰椎椎体间融合术在腰椎手术中的应用

目的探讨经椎间孔腰椎椎体间融合术(TLIF)在腰椎手术中的作用。方法对2006年12月-2008年12月间,我们应用TLIF技术进行治疗的16例腰椎滑脱、7例腰椎间盘突出症术后复发、6例极外侧型腰椎间盘突出症、5例退变性腰椎管狭窄伴腰椎不稳和1例巨大型腰椎间盘突出症患者的临床资料进行了回顾性分析。结果本组手术时间100～150min,平均130min,出血量200～750ml,平均370ml。无术中、术后并发症。术后平均随访12.7个月,末次随访临床结果优29例,良5例,可1例。结论 TLIF手术适用于不同类型的腰椎疾患,尤其适用于翻修手术,疗效可靠,值得推广应用。     

椎间盘镜治疗椎间孔外突出型极外侧型腰椎间盘突出症

目的 探讨椎间盘镜治疗椎间孔外侧突出型极外侧型腰椎间盘突出症的临床价值.方法 回顾性分析应用椎间盘镜经椎旁肌小关节外侧入路治疗16例椎间孔外侧突出型极外侧型腰椎间盘突出症,完成神经根探查、减压和髓核摘除,疗效按Macnab标准评估.结果 平均手术时间41 min,平均术中出血量70 mL,全部患者经平均15个月随访,优...     

椎间孔型腰椎间盘突出症手术治疗18例

目的：研究椎间孔型腰椎间盘突出症的临床特点和手术方法。方法：对１８例椎间孔型腰椎间盘突出症患者行手术治疗,其中棘突椎板切除术３例,单侧显露棘突悬留式腰椎管扩大术加一侧部分关节突切除术４例,单侧显露棘突悬留式腰椎管扩大术加一侧关节突全部切除８例,经腹膜外前路椎间盘切除术３例。结果：本组１８例经６￣４８个月随访,总优良率达８３．３％。结论：椎间孔型腰椎间盘突出症的症状较重,多数需手术治疗,应根据ＣＴ诊     

经皮椎间孔镜单切口治疗多间隙腰椎间盘突出症

目的探讨经皮椎间孔镜单切口治疗多间隙腰椎间盘突出症的安全性及有效性。方法回顾性分析自2009-06—2015-06采用经皮椎间孔镜单切口髓核摘除术治疗的30例多间隙腰椎间盘突出症。通过VAS、ODI评分及Macnab评分标准评价手术疗效。结果所有患者均获得随访0.5~5年,平均2.4年。术后3个月、末次随访时VAS评分较术前明显降低,且末次随访时低于术后3个月;术后3个月、末次随访时ODI评分较术前明显降低,差异有统计学意义(P0.05)。末次随访时Macnab评分:优21例,良5例,可1例,差2例,优良率86.7%。结论虽然单切口经皮椎间孔镜治疗多间隙腰椎间盘突出症手术有一定难度,但是术后效果满意,且安全有效。     

经椎间孔椎间融合术治疗高位腰椎间盘突出症

[摘要]目的：研究经椎间孔椎间融合术治疗高位腰椎间盘突出症的临床疗效及优点。方法：回顾性总结分析经椎间孔椎间融合术（TLIF）结合椎弓根内固定治疗12例高位腰椎间盘突出症的手术方法、效果及优点。结果：手术平均时间100min,术中平均出血450ml,无神经损伤、无脑脊液漏及切口感染等并发症。所有病例JOA评分优良率为90％,     

椎板原位回植椎间融合术治疗腰椎间盘突出症疗效分析

目的探讨椎板原位回植椎间融合术治疗腰椎间盘突出症的临床疗效。方法回顾性分析自2010-01—2016-12采用椎板原位回植椎间融合术治疗的192例腰椎间盘突出症,比较手术前后疼痛VAS评分、JOA评分、ODI指数。结果192例均顺利完成手术,随访时间平均24.8(15～36)个月。末次随访时按Macnab标准评定疗效:优119例,良64例,可9例,优良率95.31%。随访期间共出现17例硬膜外纤维化,31例邻近节段退变。术后3、6、12个月及末次随访时疼痛VAS评分、JOA评分、ODI指数较术前明显改善,差异有统计学意义(P 0.05)。结论椎板原位回植椎间融合术治疗腰椎间盘突出症临床疗效满意,术后并发症发生率低。     

Diagnosis and operative treatment of intraforaminal and extraforaminal nerve root compression.

The clinical, radiologic, and operative findings, and clinical results in 26 cases of foraminal nerve root involvement, each treated by variable operative procedures for an existing pathologic condition, were studied. These 26 cases consisted of 8 intraforaminal or extraforaminal lumbar disc herniations and 18 foraminal nerve root entrapments. The cases with an extreme lateral lumbar disc herniation underwent lateral fenestration or osteoplastic hemilaminectomy without concomitant spinal fusion, and showed excellent operative results. A sufficient selective decompression was achieved with a good clinical result in the cases of lumbar spondylosis without preoperative spinal instability, by lateral fenestration or osteoplastic hemilaminectomy. This result suggests that the selective decompression procedure is recommended for cases with reliable preoperative diagnoses. When an intraspinal lesion makes it difficult to diagnose coexisting foraminal nerve root involvement, decompression of the nerve root canal, approaching from medial to lateral, is recommended. The fusion operation should be performed in cases undergoing even a unilateral total facetectomy, regardless of the patient's old age. A correct preoperative diagnosis is crucial in order to obtain satisfactory operative results.     

Foraminal and extraforaminal lumbar disc herniation: diagnosis and treatment

During a 1-year period from December 1, 1984, through November 30, 1985, a total of 174 patients underwent lumbar discectomy for herniated nucleus pulposus. Eighteen (10.3%) were diagnosed as having foraminal or extraforaminal disc herniations. Sixteen patients are included in this study. All patients were evaluated with computed tomography, metrizamide myelography, discography, and discography-enhanced computed tomography (disco-CT). Accurate diagnosis of foraminal or extraforaminal herniation was made with disco-CT in 15 of 16 cases (93.8%), compared with discography alone (37.5%), computed tomography alone, and/or myelography-enhanced computed tomography (50%) and myelography alone (12.5%). Surgical treatment with bilateral hemilaminectomy, partial medial facetectomy, and partial internal foraminotomy, if needed, followed by discectomy is very effective and the favored surgical management for nerve root decompression in most all cases.     

Combined intra-extracanal approach to lumbosacral disc herniations with bi-radicular involvement. Technical considerations from a surgical series of 15 cases

Large lumbosacral disc herniations effacing both the paramedian and the foraminal area often cause double radicular compression. Surgical management of these lesions may be difficult. A traditional interlaminar approach usually brings into view only the paramedian portion of the intervertebral disc, unless the lateral bone removal is considerably increased. Conversely, the numerous far-lateral approaches proposed for removing foraminal or extraforaminal disc herniations would decompress the exiting nerve root only. Overall, these approaches share the drawback of controlling the neuroforamen on one side alone. A combined intra-extraforaminal exposure is a useful yet rarely reported approach. Over a 3-year period, 15 patients with bi-radicular symptoms due to large disc herniations of the lumbar spine underwent surgery through a combined intra-extracanal approach. A standard medial exposure with an almost complete hemilaminectomy of the upper vertebra was combined with an extraforaminal exposure, achieved by minimal drilling of the inferior facet joint, the lateral border of the pars interarticularis and the inferior margin of the superior transverse process. The herniated discs were removed using key maneuvers made feasible by working simultaneously on both operative windows. In all cases the disc herniation could be completely removed, thus decompressing both nerve roots. Radicular pain was fully relieved without procedure-related morbidity. The intra-extraforaminal exposure was particularly useful in identifying the extraforaminal nerve root early. Early identification was especially advantageous when periradicular scar tissue hid the nerve root from view, as it did in patients who had undergone previous surgery at the same site or had long-standing radicular symptoms. Controlling the foramen on both sides also reduced the risk of leaving residual disc fragments. A curved probe was used to push the disc material outside the foramen. In conclusion, specific surgical maneuvers made feasible by a simultaneous extraspinal and intraspinal exposure allow quick, safe and complete removal of lumbosacral disc herniations with paramedian and foraminal extension.     

极外侧型腰椎间盘突出症的诊治分析

目的探讨极外侧型腰椎间盘突出症（FLLDH）的诊治特点和术式选择。方法23例FLLDH患者中,其中椎间孔型14例,椎间孔外型9例。23例患者中腰痛8例（占31％）,下肢痛21例（占91％）,直腿抬高试验10例（43％）,CT或MRI可清楚地显示位于椎间孔或孔外缘突出的椎间盘。分别采用经后正中入路椎板扩大开窗术,椎间孔切开和椎弓根内固定植骨融合术,或经肌间隙入路髓核摘除术。疗效按Macnab标准评估。结果22例患者经平均3．6年随访,优15例,良4例,可3例,无差,优良率达86％。在可的3例中,其中1例为经旁正中入路手术,另2例为椎间孔型FLLDH,周缘钙化。结论症状和体征表现常以较高神经节段受损为主,下肢痛是主要症状,CT或MRI是诊断的主要依据。对椎间孔型FLLDH可采用椎板间扩大开窗术;对椎间孔外型FLLDH则需行经椎间孔切开术并辅以经椎弓根内固定植骨融合,亦可采用经肌间隙入路髓核摘除术。     

手术治疗高位腰椎间盘突出症60例

目的探讨高位腰椎间盘突出症的临床特点、诊断及治疗方法。方法60例高位腰椎间盘突出症患者中,15例行全椎板减压髓核摘除内固定,8例行半椎板减压髓核摘除,7例行双侧开窗髓核摘除,3例行经峡部外缘入路髓核摘除,27例行单侧开窗髓核摘除（其中神经根管扩大6例）。结果60例均获随访,时间6～36个月。术中硬脊膜破裂脑脊液漏3例,无神经损伤病例出现。参考陆裕朴疗效评定标准：优50例,良8例,可2例,优良率96.7%。结论高位腰椎间盘突出症的临床表现复杂,应根据临床查体结合影像学检查选择手术入路。对于年轻、单节段及旁侧型的椎间盘突出症者选择单侧开窗或半椎板减压髓核摘除;对多间隙、中央型突出髓核大者选择双侧开窗或全椎板减压髓核摘除加内固定。     

极外侧腰椎间盘突出症的临床分型及手术方式选择

目的 提出极外侧腰椎间盘突出症的新的临床分型,为手术方式的选择提供依据.方法 按照椎间盘突出的位置及其临床症状将极外侧腰椎间盘突出症分为椎管内椎间孔内型(Ⅰ型)、椎间孔内型(Ⅱ型)和椎间孔外型(Ⅲ型).据此对2002年1月至2007年1月收治的38例极外侧椎间盘突出症患者进行临床分型,并结合临床分型选择(1)经横突间椎间盘切除;(2)经椎管部分关节突切除、潜行椎间盘切除;(3)经椎管椎间盘切除+经后路椎体间融合(PLIF)等手术方式.38例患者中男性25例,女性13例;平均58.4岁.其中L_(3～4) 17例、L_ (4～5) 13例、L_5S_1 8例.单纯椎间盘突出23例,合并椎管狭窄15例.所有病例均表现为突出节段出口根受压的症状和体征,其中Ⅰ型中的7例同时伴有下位神经根受压的表现,15例合并椎管狭窄者存在间歇性跛行,21例有明确的腰痛症状.手术前后行根性疼痛VAS评分,术后采用MacNab方法进行临床疗效评定.结果 按照新的临床分型,38例患者中Ⅰ型10例、Ⅱ型19例、Ⅲ型9例.经横突间行椎间盘切除5例,经椎管部分关节突切除、潜行椎间盘切除7例,经椎管椎间盘切除+PLIF 26例.随访时间6个月～4年10个月,平均2年11个月.VAS评分术前平均为7.4分,术后2周为2.7分,末次随访为3.1分.末次随访MacNab评定结果:优20例、良12例、可5例、差1例,优良率为84.2%.并发症:伤口表浅感染1例、减压不满意者1例、脑脊液漏1例.未见内固定断裂、松动等.结论 新的临床分型,对认识极外侧腰椎间盘突出症的病理变化及选择手术方式等具有重要的意义.     

经椎间孔内镜下椎间盘摘除术初步体会

目的 评价经椎间孔内镜下椎间盘摘除术治疗椎间孔内或极外侧椎间盘突出症疗效.方法 选取2005年1月到2006年12月间32例连续接受经椎间孔内镜下椎间盘摘除术治疗患者,年龄18岁至46岁(平均28.3岁).通过临床量表和问卷的形式以VAS评分和Macnab标准比较手术前后腰腿痛的缓解程度.结果 所有患者均为单节段病损.其中5例为腰3-4、其余27例为腰4-5椎间盘突出.两例术后出现短暂小腿及足外侧感觉减退,另一例由于手术减压不完全,3d后行切开减压.平均随访20.8月(15～27月),平均VAS评分由术前的7.8降到术后的3.4.根据Macnab标准,优良率为93.7%.结论 经椎间孔内镜下椎间盘摘除术是治疗椎间孔内或极外侧椎间盘突出症的理想方法.     

极外侧型腰椎间盘突出症15例报告

目的 探讨极外侧型腰椎间盘突出症的临床和CT特征,提高该病的诊断率。方法 对15例经手术证实的患者临床和CT影像进行回顾性分析。结果 腰4／5间隙多发,椎间孔和椎间孔外联合突出多见,临床上常可见单侧两节神经根受损的表现。结论 临床与CT相结合是诊断极外侧型腰椎间盘突出症的关键。     

极外侧腰椎间盘突出症的分型治疗

目的评价2种不同的手术方式治疗不同部位的极外侧腰椎间盘突出症的效果。方法极外侧腰椎间盘突出症11例,按突出部位分为椎间孔内型和椎间孔外型椎间盘突出,椎间孔内型椎间盘突出采用后路关节突切除,切除椎间盘、椎间植骨融合内固定术;椎间孔外型椎间盘突出采用经横突间入路单纯椎间盘切除术。结果横突间入路进行椎间盘切除平均手术时间50min,平均出血量180ml;后路椎间植骨融合内固定手术平均出血量330ml,平均手术时间120min。所有患者术后下肢疼痛症状均明显减轻或消失,神经根牵拉试验正常。经过平均术后12个月的随访,除2例术前部分肌力恢复不良外,其余患者恢复正常生活和工作。结论极外侧腰椎间盘突出症根据不同的突出部位分为2种类型,适宜采取不同的手术方式。     

Transforaminal percutaneous endoscopic discectomy in the treatment of foraminal and extraforaminal lumbar disc herniations

The objective of this study is to evaluate the efficacy of the endoscopic technique, as applied to patients with foraminal and extraforaminal disc herniations, and to report the outcome and complications. A retrospective analysis was performed of 35 consecutive cases of foraminal and extraforaminal lumbar disc herniation managed by posterolateral endoscopic discectomy. Pain was measured by means of the Visual Analog Score. Patient satisfaction was evaluated by the Macnab outcome criteria. The median follow-up period was 18 months (range 10 to 35 months). The mean Visual Analog Score improved from 8.6 before the surgery to 3.2 after the surgery. Overall, excellent or good outcomes were obtained in 30 (85.7%) of the 35 patients at the last follow-up examination, with both these outcomes showing statistically significant improvement (P<0.01). There were no complications related to the surgery, nor was any spinal instability detected. Three patients (8.6%) experienced persistent radiculopathy and subsequently underwent open microdiscectomy at the same level. We concluded that transforaminal percutaneous endoscopic discectomy is safe and efficacious in the treatment of foraminal or extraforaminal disc herniations. However, proper patient selection is paramount to ensure a satisfactory outcome after decompression of foraminal and extraforaminal disc herniations.