巨大型腰椎间盘突出症的手术治疗
Journal of Clinical Orthopaedics(2010)
Abstract
目的探讨巨大型腰椎间盘突出症手术治疗的效果。方法28例巨大型腰椎间盘突出症患者中,8例行单侧扩大开窗减压髓核摘除,6例行双侧开窗减压,6例行后路半椎板切除减压髓核摘除,8例行后路全椎板切除减压髓核摘除;28例均行椎弓根螺钉固定。16例行椎间自体髂骨植骨,12例行cage椎间植骨术。单侧椎间植骨融合14例,双侧椎间植骨融合14例。应用JOA评分评价患者手术前后及随访时的神经功能,观察植骨融合情况。结果2例硬脊膜撕裂,1例出现单侧神经根麻痹。JOA评分由术前(11.85±2.41)分提高到术后(25.34±3.23)分,优良率为83.78%。其中单侧开窗组评分由术前(11.60±2.30)分术后改善到(24.85±3.30)分,优良率83.06%;双侧开窗组由术前(11.50±2.40)分术后改善到(25.50±3.20)分,优良率81.12%;半椎板切除组由术前(11.71±2.34)分术后改善到(25.83±3.41)分,优良率86.36%;全椎板切除组由术前(11.92±2.53)分术后改善到(24.49±3.19)分,优良率80.00%。患者均获随访,时间18~66个月,随访期内26例获得骨性融合,融合率为92.85%。结论巨大型腰椎间盘突出症采用手术治疗是必要的,后路开窗、半椎板、全椎板切除减压加椎间植骨内固定术均可取得良好的临床疗效,可根据患者临床症状及影像学特点选择术式,同时应进行固定融合术。
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Key words
spinal fusion,lumbar disc herniation
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