单椎板开窗减压椎间盘切除椎间融合内固定治疗腰椎间盘突出症的分析

摘要

Objective:To evaluate the curative effect of single decompression combined with discectomy,posterior intervertebral body fusion and pedicle screw fixation in the treatment of prolapse of lumbar intervertebral disc.Methods:Twenty-three patients with prolapse of lumbar intervertebral disc were received comprehensive treatment of decompression,discectomy,posterior intervertebral body fusion and pedicle screw fixation,and followed up.In the study patients, 20 cases was 1-spinal cord (L4-5 or L5-S1),and 3 were 2-spinal cord (L4-5 or L5-S1).On the basis of the area of lumbar intervertebral disc,there were 2 central, 8 para-central,10 lateral and 3 far-lateral types cases in all patients.After operation,all patients were followed up from 8 to 16 months to perform the visual analogue scale(VAS),evaluate the oswestry disability index(ODl) and to examine the relative distance of intervertebral space(R).Notably,the interbody fusion status of each case was specially observed.Results:The statistical data revealed that the values of VAS,ODI and R were respectively 8.8±0.5,(53.25±9.35)%, 0.180±0.050 before operation.Six months following operation,the three periodontal index were respectively 1.9±0.6,(19.26±5.50)%,0.326±0.038,significantly improved relative to preoperation (P<0.05).One year after operation,the rate of fusion was 100%,without fixture rupturing or loosing.Conclusion:Combined treatment of prolapse of lumbar intervertebral disc with decompression,discectomy,posterior intervertebral body fusion and pedicle screw fixation can get satisfactory clinical outcome.%　　目的：观察单椎板减压椎间盘切除椎间植骨融合椎弓根螺钉内固定治疗腰椎间盘突出症的临床疗效。方法：对23例腰椎间盘突出症患者均行后路单椎板开窗减压椎间盘切除植骨融合内固定手术治疗且获得随访，其中单节段20例(L4~5或L5~S1)，双节段3例(L4~5和L5~S1)，按腰椎间盘突出症区域水平定位中央区2例，旁中央区8例，外侧区10例，极外侧区3例。术前、术后8~16个月随访时进行疼痛视觉模拟评分(VAS)、Oswestry功能障碍指数(ODl)评估和椎间隙相对高度(R)测量，观察植骨融合情况。结果：术前VAS、ODI及R分别为(8.8±0.5)分、(53.25±9.35)%、0.180±0.050、术后半年VAS、ODI及R分别为(1.9±0.6)分、(19.26±5.50)%、0.326±0.038，较术前均有明显改善(P<0.05)。术后1年椎体全部融合，融合率为100%，内固定物位置佳，无松动、脱出、折断等。结论：采用后路行单椎板开窗减压椎间盘切除椎间植骨椎弓根螺钉内固定治疗腰椎间盘突出症可获得良好效果。