极外型腰椎间盘突出症不同手术入路治疗的探讨

目的:探讨极外型腰椎间盘突出症的不同手术入路的适应证及优缺点。方法:突出位于椎间孔内的3例采用椎管内入路,其中2例保留关节突,1例切除椎弓峡门路及上下关节突。突出位于椎间孔外的3例采用椎旁肌间隙入路。结果:6例均得到随访,其中优5例,良1例,效果满意。结论:位于椎间孔内突出和合并后外侧突出或椎管狭窄的椎间孔内突出应选择椎管内手术入路。向上移位的椎间孔内突出和位于出口区及椎间孔外突出应选择椎旁椎板侧方入路或椎旁肌间隙入路。椎旁肌间隙入路避免了椎板侧方入路骶棘肌过多剥离的缺点,值得推荐。

Treatment of extreme Iumbar disc herniation by various operative approachs

Objective:To probe the indication,advantage and shortcoming of different operative methods of extreme lateral lumbar disc hernia ion.Methods:The intraspinal canal approach was utilized in 3 cases,the paraspinal approach between multi-fidus and longissimus muscle was used in 3cases.Result:6 cases were followed-up and the result was satisfactory.Conclusion:The intraspinal canal approach should be selected when herniation is located in intervertebral foramen and is complicated with vertebral canal stenosis and post-lateral herniation.The paraspinal approach should be selected when foraminal herniation protruding to upper 1/2 of the foramen. Extreme lateral lumbar disc herniation is located at lateral zone and farlateral zone.The approach between multifidus and longissimus muscle should be recommended because of less stripped of the sacrospinals.