微创开放式腰椎间盘突出症和椎管狭窄症手术适应证的选择

目的 探讨影像学检查和手术方法对腰椎间盘突出症和椎管狭窄症手术方式和适应证的影响。方法自1999年1月-2004年12月，为300例腰椎间盘突出症和椎管狭窄症患者实施微创开放式手术，做3．5-4．5cm长的皮肤切口，剥离椎间的部分骶棘肌，咬除部分椎板上缘及小关节内侧缘后，摘除髓核，并根据需要做半椎板或全椎板手术或扩大神经根管和切除肥厚的黄韧带及神经管内的骨性增生。结果术后随访5-77个月，平均32个月，按Nakai标准评定疗效：优254例，良41例，可5例（其中在外地做过椎间盘镜术3例，木瓜酶溶核术后1例，而后到本院行此手术）。差0例。结论影像学检查为腰椎管狭窄症，黄韧带肥厚的患者。体征与狭窄的定位，在腰椎间盘突出症和腰椎管狭窄症手术方式和适应证的选择上起重要作用。根据临床症状、体征是确定狭窄区域及黄韧带肥厚挤压为重要指征，决定开窗、半椎板或全椎板手术入路最为适宜。手术方法的改进，手术适应证相对放宽，疗效也更好。

Selection of the indication of minimal invasive open operation for the treatment of lumbar disc herniation and lumbar canal stenosis

Objective To investigate the effect of radiography and method of operation on the surgical indication as well as the operation treatment of lumbar disc herniation and lumbar canal stenosis. Methods The data of 300 cases with lumbar disc herniation and lumbar canal stenosis were reviewed from Jan 1999 to Dec 2004. All cases were treated by the method of minimal invasive open operation. The nucleus was resected through an 3.5-4.5cm in length. The sacrospinalis muscle between laminae was stripped partly and the part of upper lamina and the part of medial facet was resected. Total laminectomy or half laminectomy would be selected or the nerve root canal was decompressed and hypertrophied ligmentum flavum was removed along with the herriated disc was extirpated if necessary. Results All cases were followed from 5 months to 77 months, with an average of 32 months. According to the Nakai scale, the results were excellent in 254 cases, good in 41, fair in 5 and poor in none. Including 3 cases who had been operated by microendoscopic tubular retractor, and another one had a history of chemonucleolysis. Conclusion Radiography is very important for suitable selection of surgical indication as well as the operation treatmeat of lumbar disc herniation and lumbar canal stenosis. The operation treatment should be selected to comfirm accurate dignosis and the operation approach should be based on localization and the sign of hypertrophied ligamentum flavum. Wider indication and more satisfactory outcome could be attained with the improved operation method.