后方经关节突入路治疗高位腰椎间盘突出症

目的探讨后方经关节突入路治疗高位腰椎间盘突出症的可行性及手术疗效。方法本组17例均为L1～L3间盘突出症患者,其中行单侧小关节切除髓核摘除、植骨融合、椎弓根钉内固定术13例;行双侧小关节切除髓核摘除、植骨融合、椎弓根钉内固定术4例。结果所有病例均获得12～16个月随访（平均随访时间14个月）,术后Oswestry功能障碍指数（Oswestry dysfunction index,ODI）由术前的（88.1±5.8）%改善为术后的（47.9±4.9）%,手术前后比较,差异有统计学意义（t=14.754,P=0.003）;按日本矫形外科学会（JapaneseOrthopaedic Association,JOA）评分标准,手术优良率为94.1%（16/17）,术中未发生脊髓、神经根及重要血管等损伤,术后无植骨不融合和内固定失败。结论后方经关节突入路治疗高位腰椎间盘突出症安全有效,具有创伤小、并发症少、疗效好等优点。

Posterior articular process approach for the treatment of upper lumbar disc herniation

Objective To investigate the feasibility and surgical effects of posterior articular process approach for the treatment of L1-L3 lumbar disc herniation. Methods A retrospective study of 17 patients with upper lumbar intervertebral disc herniation was carried out, in which 13 patients were treated with unilateral articular process excision and nucleus pulposus resection, lumbar interbody fusion and pedicle screw internal fixation while 4 patients were treated with bilateral articular process excision and nucleus pulposus resection, lumbar interbody fusion and pedicle screw internal fixation. Results All patients had an average follow-up period of 14 months （12-16 months）. Preoperate Oswestry dysfunction index （ODI） was （88.1 ± 5.8）% and postoperative ODI was （47.9 ± 4.9）% respectively, which showed significant improvement （t = 14.754, P = 0.003）; According to Japa- nese Orthopaedic Association （JOA） scores, the total excellent-to-good rate was 94.1% （16/17）. No injuries of spinal cord, nerve root and blood vessels occurred during the operation, and X-ray showed that all cases had bone graft fusion without internal fixation failure. Conclusion Operation through posterior articular process approach is a feasible surgical method for upper lumbar disc herniation with the advantages of minimal invasion, less complications and satisfactory clinical effects.