游离型腰椎间盘突出症的手术治疗

摘要

Objective To evaluate the clinical efficacy of neucleus extraction for the sequested lumbar disc herniation. Methods 58 patients with sequested lumber disc herniation were treated surgically between Jan. 2003-Dec. 2009. There were 31 males and 27 females with average age of 38. 5 years(range froml9 to 54 years). L3-4were involved in 3 cases,L4-5 in 29 cases,L5S1in 26 cases. The patients were treated by window-open,semi-laminectomy,complete laminectomy respectively based on site of herniation. The duration,symptoms and signs,the radiology performance and the operation treatment result were discussed. Results All the patients were followed-up for an average of 3. 5 years (range 1 to 6 years). The surgery time was(1. 0±0. 2) hours and the bleeding was(280±25) mL. Complications included cerebrospinal fluid leakage in 6 cases .unilateral transient lower extremity paresthesia in 2 cases. According to Nakai Criterion,the result for the operative treatment was excellent in 24cases,good in 27 cases,fair in 5 cases,poor in 2 cases. The rate of excellent and good results was 87. 9%. Conclusion The sequested neucleus extracted completely is a good method for the sequested lumbar disc herniation.%目的 评价游离髓核摘除术治疗游离型腰椎间盘突出症的疗效.方法 2003年1月至2009年12月采用游离髓核摘除术治疗游离型腰椎间盘突出症69例,获得完整随访资料者58例,其中男31例,女27例,年龄19～54岁,平均38.5岁.L3～4椎间盘突出3例,L4～5椎间盘突出29例,L5S1椎间盘突出26例.根据游离髓核的位置,分别采用扩大开窗、半椎板切除和全椎板切除,摘除游离髓核,研究其发病情况、临床症状、体征、影像学表现、手术方法、术中发现及治疗效果.结果 随访时间1～6年,平均3.5年,平均手术时间(1.0±0.2)h,平均出血量(280±25)mL.硬脊膜撕破8例,一过性单侧神经根麻痹2例.末次随访复发2例,58例患者按Nakai标准评定疗效,优24例,良27例,可5例,差2例,优良率87.9％.结论 彻底摘除游离髓核是治疗游离型椎间盘突出症的较好方法.