极外型椎间盘突出症的诊断和手术治疗体会

目的探讨极外侧型腰椎间盘突出症(FLLDH)的诊治特点和术式选择。方法26例FLLDH患者中,CT或MRI可清楚地显示位于椎间孔或孔外缘突出的椎间盘。分别采用扩大开窗术、半椎板切除法椎间椎弓根内固定植骨融合术或经峡部外缘途经髓核摘除术。疗效按陆裕朴等标准评估。结果26例患者经平均3年随访,优19例,良5例,可2例,无差,优良率达92%。结论极外型椎间盘突出症是腰椎间盘突出症中一个较特殊的类型,容易造成漏诊、误诊和误治,CT或MRI是诊断的主要依据。治疗可采用扩大开窗术,半椎板切除法椎间椎弓根内固定植骨融合术或经峡部外缘途经髓核摘除术,各有优缺点。

Diagnosis and operative treatment of far lateral lumbar disc herniation

[Objective] To investigate the diagnosis and operative method of extreme lateral lumbar disc herniation(ELLDH). [Methods] In 26 cases of ELLDH, CT and MRI showed the protruded disc in and outside of the foramen clearly. Operative treatments included hemilaminotomy with medial facetectomy, facetectomy with pedical screw fixation and fusion with posteolateral bone grafting, and the transmuscular approaches. The effect was estimated according to the Lu yupu criteria. [Results] 26 cases were followed up for an average of 3 years. 19 cases achieved excellent results, 5 good, 2 fair, and 0 poor. Excellent and good resumed rate was 92%. [Conclusion] The far lateral lumbar disc herniation is the especial case of lumbar disc herniation. CT and MRI appearances are not only sensitive but also specific for the diagnosis of FLLDH. Operative treatments include hemilaminotomy with medial facetectomy, facetectomy with pedical screw fixation and fusion with posteolateral bone grafting, and the transmuscular approaches, there are some advantages or limites for each way.