腰椎间盘突出症合并腰椎管狭窄症的手术治疗（附52例临床分析）

本文报告手术治疗之腰椎间盘突出症１１８例，其中合并退变性腰椎管狭窄５２例（４４％）。由于二者具有共同的发病诱因，故一并讨论其诊断和治疗问题。诊断依据和手术指征是放射性坐骨神经痛、间歇性跛行、神经功能障碍、直腿抬高试验阳性，Ｘ线平片提示腰椎退行性改变，ＣＴ扫描证实有椎间盘突出，中央椎管矢状径＜１１．５ｍｍ，侧隐窝矢状径＜３ｍｍ，黄韧带厚度＞４ｍｍ或伴有骨化以及后纵韧带骨化。手术方式是全椎板切除、半椎板切除，间盘切除同时扩大侧隐窝以使被卡压的神经根获得彻底减压，使其能移动０．５～１ｃｍ。除有退变性或椎弓崩裂性滑脱不作融合术。术后随访４５例，随访时间３个月～５年，优良率８６．５％，无腰椎不稳和腰椎滑脱等并发症。为获得优良效果，作者强调在处理椎间盘突出的同时必须彻底解除侧隐窝狭窄对神经根的压迫，才能彻底根除症状。

Surgical treatment of lumbar disc protrusion with lumbar spinal stenosis a clinical analysis of 52 cases

cases lumbar disc protrusion by surgical treatment were reported.Of these, 52 cases (44%)were found accompanied with spinal stenosis.There are same pathogenesis for the lumbar disc protrusion and degenerative lumbar spinal stenosis.Hence both diseases were disccused togather on the diagnosis and treatment.Diagnostic criteria and indications of surgical treatment are radicular sciatica,intermittent claudication,neurologic defects, positive Laseque's sign, evidence of degenerative changes of lumbar spine suggested by plain x-ray film,diac protrusion,central spinal canal sagital diameter<11.5mm,lateral recces sagital diameter<3mm,ligmentum flavum thickening>4mm or ossification and OPLL confirmed by CT scanning. The procedures are total laminectomy,hemilaminectomy and descectomy, enlarging the lateral recces to release the nerve root compresed. Let it free range from 0.5 to 1cm.Fusion of the spine was no performed except degenerative or spondylolytic spondylolisthesis.45 patients were followed up for 3months-5 years.Excellent and good rate were 86.5%. No complications such as lumbar spine instability or spondylolisthesis occurred after wide laminectomy. For a better outcome the author emphasized that it must be dealt with lateral recces stenosis constituded compresion to the nerve root at discectomy.So that the symptoms can be eradicated thoroughly.