Application of Small Incision Unilateral Finite Vertebral Fenestration for Intervertebral Disk Extirpation Combined with Lateral Recess Enlargement Technique In Aged Patients_West China Medical Journal

Authors：

ZHU Chengming ¹ , ZHANG Deming ¹ , YAO Wenhua ¹ , WANG Guifu ²

1. Department of Neurosurgery, Ya’an People’s Hospital, Ya’an, Sichuan 625000, P. R. China; 2. Department of Neurosurgery, Zunyi Medical College, Zunyi, Guizhou 563003, P. R. China;

Corresponding?author：

Keywords：

腰椎間盤突出癥; 側隱窩狹窄; 小切口; 開窗法; 老年人

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目的　探討老年人腰椎間盤突出合并側隱窩狹窄癥的臨床特點及手術方式，總結和介紹小切口單側椎板開窗椎間盤摘除聯合側隱窩擴大術的優點和可行性。方法　2006年7月－2011年1月對76例患者行后正中切口4.0～6.0 cm，在C臂X線機定位下，保留棘上、棘間韌帶和棘突，骨膜下剝離骶棘肌，顯露椎板、椎板間隙和關節突起，在椎板間隙間開骨窗，切除關節突內側小部分后，環形切除突出的纖維環取出髓核，擴大成形側隱窩，解除所有卡壓脊神經根組織，徹底松解脊神經根。結果　術后76例隨訪15～24個月，平均18個月，均按中華脊柱外科學會脊柱學組腰腿痛手術評定標準評定：優63例，良10例，一般及差3例，優良率達96.05%。手術前后Oswestry功能障礙指數評分與腰痛及腿痛視覺模擬評分法評分比較，差異有統計學意義（P＜0.05）。結論　小切口單側椎板開窗椎間盤摘除聯合側隱窩擴大術，是一種手術創傷小，能在直視下操作，避免手術失誤，徹底去除神經根致壓物，不僅能夠擴大神經根管，而且可行側隱窩的探查及松解，同時兼顧脊柱穩定結構基本不被破壞，療效滿意，尤其在老年人中值得推廣。

Citation： ZHU Chengming,ZHANG Deming,YAO Wenhua,WANG Guifu. Application of Small Incision Unilateral Finite Vertebral Fenestration for Intervertebral Disk Extirpation Combined with Lateral Recess Enlargement Technique In Aged Patients. West China Medical Journal, 2012, 27(11): 1629-1633. doi: Copy

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10.	張輝, 梁業, 梁善榮, 等. 中老年腰椎間盤突出癥髓核摘術后高復發原因分析[J]. 頸腰痛雜志, 2010, 31(1): 44-45.
11.	Ostemian H, Sund R. Risk of multiple reoperations after lumbar discectomy[J]. Spine (Phila Pa 1976), 2003, 28(6): 621-631.
12.	李智斐, 鐘遠鳴, 張家立, 等. 腰椎間盤突出癥術后遲發性腦脊液漏的治療體會[J]. 廣西醫學, 2011, 33(2): 222-223.
13.	Koebbe CJ, Maroon JC, Abla A, et al. Lumbar micro discectomy:a historical perspective and current technicalconsiderations[J]. Neurosurg Focus, 2002, 13(02): 3-6.
14.	王靖, 唐天駟, 滕紅林, 等. 局麻側臥位開窗髓核摘除治療伴心肺合并疾病的老年腰椎間盤突出癥[J]. 臨床骨科雜志, 2011, 14(1): 9-11.
15.	Maroon JC. Current concepts in minimally invasive discectomy[J]. Neurosurgery, 2002, 51(5 Suppl): 137-145.

1. 　楊惠林, 唐天駟. 中華骨科學會脊柱學組腰痛評定標準(腰椎不穩與椎管狹窄專題研討會紀要)[J]. 中華骨科雜志, 1994, 1(14): 60.
2. 　王光元, 趙友海. 小切口開窗治療腰椎間盤突出癥中遠期臨床觀察[J]. 中國社區醫師:醫學專業, 2011, 13(12): 95-96.
3. 　Wang S, Wang F. The treatment method and effect analysises of lumbar disk herniation[J]. Journal of Practical Orthopedies, 2004, 10(1): 52-53.
4. 　Erol DD, Ozen I. Is general anesthesia a risk for myocardium? Effect of anesthesia on myocardial function as assessed by cardiac troponin-i in two different groups (isofluran+N2O inhalation and propofol+fentanyl iv anesthesia)[J]. Vasc Health Risk Manag, 2007, 3(5): 755-758.
5. 　Ren ZH, Lei Q, Chen L, et al. To explore reoperation of lumbar disc protrusion[J]. Chinese Journal of Modem Medicine, 2004, 14(4): 133-135.
6. 　肖奕增, 鄭文忠, 楊德育, 等. 合并內科病老年腰椎間盤突出癥微創開窗手術[J]. 臨床軍醫雜志, 2010, 38(5): 716-718.
7. 　Khoo LT，Fessler RG. Micro endoscopic decompressive laminotomy for the treatment of lumbar stenosis[J]. Neurosurgery, 2002, 51(5): 146-154.
8. 　戎利民, 蔡道幸, 董健文, 等. 顯微內鏡椎間盤摘除術治療老年腰椎問盤突出癥[J]. 中國矯形外科雜志, 2008, 19(16): 1508-1509.
9. 　Stevens KJ, Spenciner DB, Griffiths KL, et al. Comparison of minimally invasive and conventional open posterolateral lumbar fusion using magnetic resonance imaging and retraction pressure studies[J]. J Spinal Disord Tech, 2006, 19(2): 77-86.
10. 　張輝, 梁業, 梁善榮, 等. 中老年腰椎間盤突出癥髓核摘術后高復發原因分析[J]. 頸腰痛雜志, 2010, 31(1): 44-45.
11. 　Ostemian H, Sund R. Risk of multiple reoperations after lumbar discectomy[J]. Spine (Phila Pa 1976), 2003, 28(6): 621-631.
12. 　李智斐, 鐘遠鳴, 張家立, 等. 腰椎間盤突出癥術后遲發性腦脊液漏的治療體會[J]. 廣西醫學, 2011, 33(2): 222-223.
13. 　Koebbe CJ, Maroon JC, Abla A, et al. Lumbar micro discectomy:a historical perspective and current technicalconsiderations[J]. Neurosurg Focus, 2002, 13(02): 3-6.
14. 　王靖, 唐天駟, 滕紅林, 等. 局麻側臥位開窗髓核摘除治療伴心肺合并疾病的老年腰椎間盤突出癥[J]. 臨床骨科雜志, 2011, 14(1): 9-11.
15. 　Maroon JC. Current concepts in minimally invasive discectomy[J]. Neurosurgery, 2002, 51(5 Suppl): 137-145.

West China Medical Journal

Application of Small Incision Unilateral Finite Vertebral Fenestration for Intervertebral Disk Extirpation Combined with Lateral Recess Enlargement Technique In Aged Patients

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