腰椎管狭窄症合并椎间盘突出的手术方法比较

比较全椎板和大部椎板切除减压加椎间盘髓核摘除术治疗腰椎管狭窄症合并椎间盘突出病人的疗效。方法共收治腰椎管狭窄症合并椎间盘突出病人１１２例，分别采用狭窄节段上一椎体的全椎板和大部椎板切除减压加椎间盘髓核摘除术进行治疗。结果随访４２例病人，平均随访时间６．８ａ，疗效优良率达８８．１％，复发率２．４％，取得了较满意的结果。随访３２例病人的腰椎过屈过伸位片发现，大部椎板切除病人的腰椎滑移距离比全椎板切除病人的要小，差异有显著意义（Ｐ＜０．０５）。结论大部椎板切除减压加椎间盘髓核摘除治疗腰椎管狭窄症合并椎间盘突出病人，术后疗效好，并发症少，对腰椎稳定性的影响不明显，是一种安全、有效的手术方法。手术中要保留棘上韧带，术后要功能锻炼。

COMPARISON OF SURGICAL TREATMENTS FOR LUMBAR DISC HERNIATION AND SPINAL STENOSIS

PURPOSE To compare the surgical treatments of lumbar disc herniation and spinal stenosis discectomy with total laminectomy or sub total laminectomy. METHODS From 1986 to 1993, all the patients suffering from lumbar disc herniation and spinal stenosis and undergoing discectomy with total laminectomy or sub total laminectomy were studied. RESULTS Forty two cases were followed up and 88.1% of them attained excellent and good results. Recurrent rate was 2.4%. The lumbar sliding distance was significantly shorter in the sub total laminectomy group than in the total laminectomy group ( P <0.05). CONCLUSIONS The sub total laminectomy with discectomy is the better treatment for the patients with lumbar disc herniation and spinal stenosis. This treatment has better results, less complications, and less effect on the stability of the lumb. In the surgery, the supraspinous ligment should be retained and sutured. Rehabilitation is important.