CAJ | 학술논문

目的探讨高位腰椎间盘突出症的临床特点及手术方法的选择.方法 112例高位腰椎间盘突出症患者中27例行全椎板减压髓核摘除内固定,21例行半椎板减压髓核摘除,20例行双侧开窗髓核摘除,44例行单侧后路开窗髓核摘除.结果 112例均获随访,随访时间6～48个月.术后神经症状有不同程度恢复,术中硬脊膜破裂脑脊液漏13例,无神经损伤加重病例.参考中华医学会骨科学分会脊柱组腰背痛手术评定标准:优93例,良16例,可3例,优良率为97.3％.结论高位腰椎间盘突出症手术入路的确定应根据每例患者的具体情况选择.对于年轻、单节段及旁侧型的椎间盘突出症患者选择单侧开窗或半椎板减压髓核摘除；对多间隙、中央型突出髓核大者选择双侧开窗或全椎板减压髓核摘除,对严重椎管狭窄或合并椎间不稳者加椎间融合内固定.
목적 탐토고위요추간반돌출증적림상특점급수술방법적선택.방법 112례고위요추간반돌출증환자중27례행전추판감압수핵적제내고정,21례행반추판감압수핵적제,20례행쌍측개창수핵적제,44례행단측후로개창수핵적제.결과 112례균획수방,수방시간6～48개월.술후신경증상유불동정도회복,술중경척막파렬뇌척액루13례,무신경손상가중병례.삼고중화의학회골과학분회척주조요배통수술평정표준:우93례,량16례,가3례,우량솔위97.3％.결론 고위요추간반돌출증수술입로적학정응근거매례환자적구체정황선택.대우년경、단절단급방측형적추간반돌출증환자선택단측개창혹반추판감압수핵적제；대다간극、중앙형돌출수핵대자선택쌍측개창혹전추판감압수핵적제,대엄중추관협착혹합병추간불은자가추간융합내고정.
Objective To investigate the choice of operation methods and clinical features on patients with upper lumbar disc herniation.Methods All the 112 patients were treated by surgical treatment,laminectomy and internal fixation in 27 cases,semi-laminectomy in 21 cases,bilateral fenestration in 20 cases and unilateral fenestration in 44 cases.Results All the 112 patients were followed up for 6-48 months.No nerve injury was found.The results were excellent in 93 cases,good in 16 cases,and fair in 3 cases.The excellent and good rate was 97.3％.Conclusion The clinical manifestations of upper lumber disc herniation are complicated.The methods of operation should be determined by different condition:For a young,single segment and the lateral disc herniation patients,choose the unilateral window or semi-laminectomy and discectomy; For multi-gap,the central nucleus pulposus large patients,choose bilateral fenestration or laminectomydecompression discectomy; For severe spinal stenosis or merge intervertebral instability patients,choose interbody fusion and internal fixation.