高位腰椎间盘突出症的手术治疗.pdfVIP

498 中国脊柱脊髓杂志2008年第18卷第7期 Chinese Journal ofSpine and Spinal Cord，2008，Vo1．18。No．7 高位腰椎间盘突出症的手术治疗 申 勇，曹俊明，杨大龙，孟宪中，李志远，王林峰 (河北医科大学第三医院脊柱外科 050051河北省石家庄市) 【摘要】目的：探讨高位腰椎间盘突出症的手术治疗方法。方法：37例高位腰椎间盘突出症患者中，男25例．女 12例；年龄38～65岁，平均54．3岁；L1／2 7例，L2，3 13例；L3／4 17例。22例行双侧小关节切除自体小关节骨 及cage后路椎间融合椎弓根钉内固定术，15例行前路椎间盘切除植骨融合钛板内固定术。应用JOA评分评价 患者手术前后及随访时的神经功能，总结手术并发症，观察植骨融合情况。结果：后路手术患者中2例硬脊膜 撕裂．1例椎弓根螺钉位置偏斜；前路手术患者中1例硬脊膜破裂，2例术后出现单侧神经根麻痹．1例术后出 现难控制性呃逆。随访24～66个月，平均43．5个月，JOA评分由术前 l1．85_+2．41分提高到随访时的25．34~3．23 分，优良率为83．78％；其中前路手术者JOA评分由l1．92_+2．53改善到24．49--3．19分，优良率为80．00％；后路手 术者由l1．71~2．34改善到25．83-+3．41分，优良率86．36％。无内固定物松动、断裂等并发症发生，后路手术者骨 性融合率为95-45％，前路手术者骨性融合率为93．33％。结论：高位腰椎间盘突出症采用手术治疗是必要的，前 或后路手术均可取得良好的疗效。 【关键词】腰椎问盘突出症；高位；融合术；疗效 中图分类号：R681．5 文献标识码：A 文章编号：1004—406X(2008)一07—0498～04 Surgical treatment of the high level lumbar intervertebral disc herniation／SHEN Yong，CAO Junming， YANG Dalong，et al／／Chinese Journal of Spine and Spinal Cord，2008，18(7)：498-501 【Abstract】Objective：To evaluate the surgical approaches and their clinical effect of the high level lumbar intervertebral disc herniation．Method：37 patients with the high level lumbar intervertebral disc herniation were reviewed．There were 25 male and 12 female with the mean age of 54．3 years(from 38 to 65 years old)．22 patients were treated with posterior lumbar interbody fusion(PLIF)using facet joint autograft and cage in ad— dition to pedicle screw internal fixation(posterior approache group)，and 15 patients were treated with anterior diskectomy．bone grafting and plate internal fixation(anterior approache group)．The JOA scores，clinical excel— lent and good rates，radiographic findings and complications were evaluated．Result：Complications included du— ral tear(2 cases)，and pedicle screw dev