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：

腰椎间盘突出症; 侧隐窝狭窄; 小切口; 开窗法; 老年人

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目的　探讨老年人腰椎间盘突出合并侧隐窝狭窄症的临床特点及手术方式，总结和介绍小切口单侧椎板开窗椎间盘摘除联合侧隐窝扩大术的优点和可行性。方法　2006年7月－2011年1月对76例患者行后正中切口4.0～6.0 cm，在C臂X线机定位下，保留棘上、棘间韧带和棘突，骨膜下剥离骶棘肌，显露椎板、椎板间隙和关节突起，在椎板间隙间开骨窗，切除关节突内侧小部分后，环形切除突出的纤维环取出髓核，扩大成形侧隐窝，解除所有卡压脊神经根组织，彻底松解脊神经根。结果　术后76例随访15～24个月，平均18个月，均按中华脊柱外科学会脊柱学组腰腿痛手术评定标准评定：优63例，良10例，一般及差3例，优良率达96.05%。手术前后Oswestry功能障碍指数评分与腰痛及腿痛视觉模拟评分法评分比较，差异有统计学意义（P＜0.05）。结论　小切口单侧椎板开窗椎间盘摘除联合侧隐窝扩大术，是一种手术创伤小，能在直视下操作，避免手术失误，彻底去除神经根致压物，不仅能够扩大神经根管，而且可行侧隐窝的探查及松解，同时兼顾脊柱稳定结构基本不被破坏，疗效满意，尤其在老年人中值得推广。

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

1.	杨惠林, 唐天驷. 中华骨科学会脊柱学组腰痛评定标准(腰椎不稳与椎管狭窄专题研讨会纪要)[J]. 中华骨科杂志, 1994, 1(14): 60.
2.	王光元, 赵友海. 小切口开窗治疗腰椎间盘突出症中远期临床观察[J]. 中国社区医师:医学专业, 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, 郑文忠, 杨德育, 等. 合并内科病老年腰椎间盘突出症微创开窗手术[J]. 临床军医杂志, 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. 显微内镜椎间盘摘除术治疗老年腰椎问盘突出症[J]. 中国矫形外科杂志, 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.	张辉, 梁业, 梁善荣, 等. 中老年腰椎间盘突出症髓核摘术后高复发原因分析[J]. 颈腰痛杂志, 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, 钟远鸣, 张家立, 等. 腰椎间盘突出症术后迟发性脑脊液漏的治疗体会[J]. 广西医学, 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, 唐天驷, 滕红林, 等. 局麻侧卧位开窗髓核摘除治疗伴心肺合并疾病的老年腰椎间盘突出症[J]. 临床骨科杂志, 2011, 14(1): 9-11.
15.	Maroon JC. Current concepts in minimally invasive discectomy[J]. Neurosurgery, 2002, 51(5 Suppl): 137-145.

1. 　杨惠林, 唐天驷. 中华骨科学会脊柱学组腰痛评定标准(腰椎不稳与椎管狭窄专题研讨会纪要)[J]. 中华骨科杂志, 1994, 1(14): 60.
2. 　王光元, 赵友海. 小切口开窗治疗腰椎间盘突出症中远期临床观察[J]. 中国社区医师:医学专业, 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, 郑文忠, 杨德育, 等. 合并内科病老年腰椎间盘突出症微创开窗手术[J]. 临床军医杂志, 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. 显微内镜椎间盘摘除术治疗老年腰椎问盘突出症[J]. 中国矫形外科杂志, 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. 　张辉, 梁业, 梁善荣, 等. 中老年腰椎间盘突出症髓核摘术后高复发原因分析[J]. 颈腰痛杂志, 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, 钟远鸣, 张家立, 等. 腰椎间盘突出症术后迟发性脑脊液漏的治疗体会[J]. 广西医学, 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, 唐天驷, 滕红林, 等. 局麻侧卧位开窗髓核摘除治疗伴心肺合并疾病的老年腰椎间盘突出症[J]. 临床骨科杂志, 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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