6815例腰椎间盘突出症的手术治疗

目的探讨腰椎间盘突出症的手术治疗方法。方法采用脊神经后支阻滞麻醉屈曲位经椎板间隙侧方入路椎间盘摘除术、双开窗扩大减压治疗中央宽基底型椎间盘突出钙化、小切口开窗潜行减压髓核摘除术等三种方法共治疗腰椎间盘突出症6 815例。结果6 815例患者中5 324例经过半年至14年(平均6.3年)随访,优4 260例(80.02%)、良855例(16.06%)、进步209例(3.92%),优良率达96.08%。随访中X线检查显示手术后相应椎间隙不同程度的变窄,未见腰椎失稳和腰椎滑脱。结论采用的三种方法与传统术式比较创伤小,可最大限度地保留腰椎后部结构的完整性,且手术时间短、康复快。

Surgical therapy of lumbar disk herniation in 6 815 cases

Objective To explore the surgical therapy for lumbar disc herniation (LDH). Methods Under local anesthesia by blocking the posterior branches of spinal nerves, 3 surgical approaches were adopted in 6 815 LDH cases, namely discectomy by lateral and interlamina access, double fenestration and enhanced decompression for broad central LDH, and removal of nucleus pulposus with small incision and fenestration. Results Follow-up study was conducted in 5 324 cases for the duration varying from 6 months to 14 years, averaging 6.3 years. Excellent results were achieved in 4 260 cases (80.02%), good in 855 cases (16.06%) with another 209 cases (3.92%) showing symptomatic improvement. X-ray examination in these cases revealed narrowed intervertebral spaces of different degrees without lumbar instability or spondylolisthesis. Conclusion In comparison with conventional approaches, the 3 surgical approaches for LDH management may preserve the utmost integrity of the posterior lumbar structures and cause less traumatic injuries with shortened operation time and quick recovery.