腰椎间盘突出症四术式远期疗效的比较

目的：了解椎板间开窗、前入路椎体间开窗，半椎板切除，一推板切除并行髓核除四术式的远期疗效，对192例行不同方式腰椎间盘髓核除术患进行了远期疗效随访。方法：对1975－1999年上半年间行椎板间开窗术患82例，前入路椎体间开窗23例，半椎板切除术51例，全椎板切除术36例，术前及术后0．5－25a分别进行症状比较和功能测试。结果4组患术前在年龄结构、病变范围，症状方面的差异均无显性意义。术后，4组患两两之间在症状和体征方面的差异有显性意义，4组患主观感觉优良率分别96％、85％、54％、16％。结论四术式中椎板间开窗组的疗效最好，并发症最小，面全椎板切除组的疗效最差，腰椎不稳、肌萎缩和硬脊膜压迫、粘连等并发症的发生率最高。前入路椎体间开窗组和半椎板切除的情况介于中间，本讨论了造成此差异的原因。

Comparative study of Long-Term Results ofFour Different Approach for Surgical Treatment of Lumbar disc Herniation

Objective To compare the long term results of four different surgical approaches for treatment of lumbar disc herniation.Methods One hundred and ninety two patients undergone operative treatment for lumbar disc herniation during 1975 to 1999 were reviewed.Groups A consisted of 82 cases were done through between lumbar fenestration.Group B of 23 cases were done through front lumbar fenestration.Group C of 51 cases were done through semilaminectomy,and group D of 36 cases through total laminectomy.The symptoms and signs were evaluated before operation and postoperative follow up for a half to twenty five years.Results There was no significant difference between four groups in symptoms and signs before operation.However,significant difference was seen at 0.5 to 25 years follow up period,giving an excellent and good rate of 96%,85%,54%,16% respectively in the groups A,B,C and D.Conclusions The fenestration lumbar discectomy had the best outcome and the least complications,whereas the total camineceomy discectomy bore the worst outcome and the frequently encountered complications such as instability and dura compression.