椎板减压经椎间孔椎间盘切除椎间融合内固定治疗高位腰椎间盘突出症

Laminectomy with transforaminal discectomy and lumbar interbody fusion for upper lumbar disc herniation

中文关键词:  高位腰椎间盘突出症  椎间盘切除术  经椎间孔腰椎间融合术

英文关键词:Upper lumbar disc herniation  Discectomy  Transforaminal lumbar interbody fusion

中文摘要:

  【摘要】 目的：观察椎板减压经椎间孔椎间盘切除椎间植骨椎弓根螺钉内固定治疗高位腰椎间盘突出症的临床疗效。方法：2005年3月~2008年12月我院收治且获得随访的单间隙高位腰椎间盘突出症患者22例，其中L1/2 4例，L2/3 9例，L3/4 9例。均接受经椎间孔椎间盘切除椎间植骨椎弓根螺钉内固定术治疗，其中18例行单侧椎板切除减压，4例行全椎板切除减压。术前、术后1年随访时进行疼痛视觉模拟评分（VAS）、Oswestry功能障碍指数（ODI）评估和椎间隙相对高度（R）测量，观察植骨融合情况。结果：手术时间120～180min，平均132．6min，术中出血200～350ml，平均263ml。术中无硬膜损伤。1例术后出现对侧神经根牵拉伤，经对症处理后症状消失。均获得1年以上随访。术前VAS、ODI及R分别为8．3±0．6分、（52．32±9．17）%、0.211±0.052，术后1年时VAS、ODI及R分别为2．1±0．8分、（20．33±5．72）%、0.324±0.048，较术前均有明显改善（P<0．05）。1例可能不融合，融合率为95%；内置物位置佳，无松动、脱出。结论：采用椎板减压经椎间孔椎间盘切除椎间植骨融合椎弓根螺钉内固定术治疗高位腰椎间盘突出症可获得较满意疗效。

英文摘要:

  【Abstract】 Objective：To investigate the efficacy of laminectomy with transforaminal discectomy and lumbar interbody fusion for upper lumbar disc herniation.Method：22 cases with upper lumbar disc herniation undergoing laminectomy，transforamina discectomy and lumbar interbody fusion（18 cases with partial laminectomy，4 cases with total laminectomy） in our hospital from Mar 2005 to Dec 2008 were reviewed retrospectively，the involved level included L1/2 in four cases，L2/3 in nine cases and L3/4 in nine cases.Oswestry score was used to evaluate the neurological status，VAS score and Mochida′s score were used to assess low back pain and the intervertebral space height respectively before operation and 1 year after operation.Schulte method was used to evaluate the fusion status 1 year after operation.Result：The average operation time was 132.6min，the average intraoperative blood loss was 263ml and no spinal dura mater injury was noted.1 patients was complicated with contralateral nerve root stretch injury，which was resolved after conservative treatment.All the patients were followed up for more than one year.The preoperative VAS，ODI and R value were 8．3±0．6，（52．32±9．17）% and 0.211±0.052 respectively；one year after operation the counterparts were 2．1±0．8，（20．33±5．72）%，0.324±0.048 respectively，which showed significant improvement，and bony union rate was noted as 95% except 1 case of uncertain.No implant failure was found.Conclusion：Laminectomy with transforaminal discectomy and lumbar interbody fusion for upper lumbar disc herniation is reliable and effective.