双开窗治疗中央型腰椎间盘突出症及远期疗效分析

目的探讨双开窗手术治疗中央型腰椎间盘突出症及其远期临床疗效。方法回顾性分析我院在2001年6月至2005年2月期间行双开窗手术治疗中央型腰椎间盘突出症并有完整随访资料的患者42例，全部病例术前均行X线片、CT或MRI检查发现中央型腰椎间盘突出，患者同时出现双侧腰骶臀部症状或交替性腿部症状，且症状与影像学相符。对所有患者通过JOA腰背痛手术治疗评分、Macnab评定标准和生活质量量表进行评分。结果42例患者随访6个月至9年，平均6．2年，随访患者JOA评分为（23．58±6．35）；根据Macnab疗效标准，优36例，良4例，可2例，优良率达85．71％，无同节段症状复发和腰椎失稳现象发生。结论双开窗有限手术能彻底减压并维持脊柱的稳定性，且远期疗效好，是治疗中央型椎间盘突出症有效的可靠的方法。

Long-term therapeutic effect of bilateral fenestration in the treatment of central protrusion of lumbar intervertebral disc

Objective To observe the long-term clinical effect of bilateral fenestration in the treatment of central protrusion of lumbar intervertebral disc. Methods Retrospectively analyzing the 42 cases of bilateral fenestration in the treatment of central protrusion of lumbar intervertebral disc from June 2001 to February 2005. All cases had complete follow-up materials. 42 cases with central type of lumbar disc herniation were confirmed by X-ray, CT or MRI before surgery. All patients had bilateral lumbosacrum and hip symptoms simultaneously or alternating leg symptoms. And the symptoms were consistent with imaging data. The outcomes were estimated with the JOA （Japan Orthopaedic Association） standards of surgical treatment in lumbar and back pain, the Macnab＇s criteria and SF-36 quality of life scores. Results For the 42 cases, the follow-up period was from 6 months to 9 years and the average time was 6.2 years. For the patients with follow-up, the average score of JOA was 23.58＋6.35. According to Macnab＇s criteria, excellent outcomes were achieved in 36 cases, good in 4 cases and fair in 2 cases. The excellence rate was 85.71%. No recurrence of symptoms in the same segment and phenomenon of instability of lumbar segment occurred. Conclusions Bilateral fenestration is a safe treatment helping patients to recover quickly from central protrusion of lumbar intervertebral disc. It has good long-term efficacy, which could thoroughly decompress and maintain spinal stability.