96例多间隙腰椎间盘突出症的手术治疗分析

为探讨多间隙腰椎间盘突出症的特点和手术方式的选择 ,观察及分析根据不同的退变形式 ,采用不同的手术方法对 96例多间隙腰椎间盘突出症患者进行治疗 ,其中 3 8例采用传统的椎板或半椎板切除术 ,5 8例采用多间隙椎板单侧开窗或双侧蝶形开窗术 ,在此基础上摘除髓核并对神经进行减压。结果经术后 1～ 6年 ,平均 3 .4年的随访 ,两组疗效的近期优良率差异无显著性 (P >0 .0 1) ;多节段开窗组远期优良率则较高且腰椎不稳定或椎管、侧隐窝再狭窄的发生率低 (P<0 .0 5 ) ;提示多间隙椎板开窗术既可对神经进行充分的减压 ,又可以最大限度地维持脊柱的稳定性 ,是治疗多间隙腰椎间盘突出症的较好方法 ;在准确判断病变节段及退变形式的基础上 ,采用该术式可提高疗效。

Surgery treatment for the multi-loophole prolapse of lumbar intervertebral disc:A report of 96 cases

In order to research for the characteristics of multi-loophole prolapse of lumbar intervertebral disc and the operative ways for it, ninety-six patients with this disease were given different operative ways according to the different degeneration type. Thirty-eight of them received laminectomy or half-laminectomy. Fifty-eight of them underwent single multi-loophole laminectomy windowing or bilateral butterfly windowing , on the basis of this, the pulpiform nucleus was extracted to decrease the pressure of the nerves. After the follow-up of 1～6 year surgery (mean 3.4 years), there were no statistically significant difference in the excellent rate between these two groups (P>0.05); the long-term excellent rate in multiple step window group was higher and the incidences of the unstable lunbar vertebrae, the vertebral canal and the lateral crypt restricture were low (P<0.05). This study indicated that the multi-loophole laminectomy windowing could completely depress the pressure of the nerves, and maintain the stability of the spine with maximun. It is a good method to treat multi-loophole prolapse of lumbar intervertebral disc. The efficacy can be improved on the basis of the correct diagnosis of the pathologic segment and the degeneration type.