多间隙腰椎间盘突出症的手术治疗探讨

目的：探讨多间隙腰椎间盘突出症手术治疗的基本原则。方法：167例多间隙腰椎间盘突出症患者,87例行单纯椎板间开窗减压术,54例行半椎板切除加椎板间开窗减压术,17例行单纯全椎板切除减压术,9例行全椎板切除加内同定植骨融合术,287个“责任”椎间盘予髓核摘除,56个“非责任”椎间盘未予处理。结果：随访7个月～9年,原位椎间盘突出复发6例,术后继发椎管狭窄9例,腰椎不稳4例,内同定断裂1例。按改良Macnab法评定术后疗效,本组优93例,良44例,可29例,差1例,优良率为82％。结论：有效减压、维持脊柱的稳定性、避免并发症的发生是手术治疗多间隙腰椎间盘突出症应遵守的基本原则。

Surgical treatment of multiple lumbar disc herniation

Objective:To study the basic principle of surgical treatment of multiple lumbar disc herniation.Method:167 cases with multiple lumbar disc herniation were treated with a different operative method.87 cases were operated with single vertebral plate fenestration,54 cases with half vertebral plate excision plus vertebral plate fenestration,17 cases with full vertebral plate excision,9 cases with full vertebral plate excision plus internal fixation and fusion.287 "responsible disc" were exscinded,56 "non-responsible disc" were treated with conservative method.Result:Excellent in 93 cases,good in 44 cases,normal in 29 cases,bad in 1 case.The fineness ratio was 82%.All the cases were followed up 7 months to 9 years.Recurrence of the lumbar disc herniation in situ was seen in 6 cases,secondary spinal stenosis in 9 cases,spinal instability in 4 cases,internal fixation breakdown in 1 case.Conclusion:Effective decompression,maintenance of the spinal stabilization and avoidance of the complications are the basic principles in treating multiple lumbar disc herniation.