腰椎间盘突出后路手术的回顾性研究

摘要

目的 探讨不同腰椎间盘突出后路手术的手术效果.方法 选择该院收治的8 000余例腰椎间盘突出后路手术患者进行研究,对不同时期患者采用术式的技术要点进行分类,并观察术式实施结果.结果 1980年1月至1990年12月患者采用全椎板术式;1991年1月至2000年12月患者采用全椎板、半椎板;2001年1月至2012年12月患者术式中开窗式占86.0％,扩大开窗式或半椎板占11.0％,全椎板仅为3.0％.2000年后病例诊断准确率98.0％,手术后效果优良率99.8％,平均手术时间(80±15)min,失血量平均(100±20)mL.术后伤口10～12 d拆线,Ⅰ/甲类愈合99.8％,硬脊膜撕裂率为4.0％,神经根损伤率为0.5％,脑脊液漏发生率为0.9％.2000年之后的病例中并发症发生率显著下降.结论 总结腰椎间盘突出后路手术的操作技术要领,避免操作失误,可降低手术损伤并发症的发生率.%Objective To study the effect of different therapies for posterior lumbar disc herniation.Methods A total of 8 000 patients with lumbar disc posterior surgery were enrolled in this research at our hospital.The technical points of the patients in different times were analysed.The results of the operation were observed.Results From January 1980 to December 1990,patients underwent laminectomy.From January 1991 to December 2000,patients were treated with laminectomy and semi-lamina.From January 2001 to December 2016,the open window accounted for 86.0％,expanding the window or semi-lamina accounted for 11.0％,and the whole laminar plate only accounted for 3.0％.After 2000,the accuracy of the diagnosis was 98.0％,the excellent rate of operation was 99.8％,the average operation time was(80±15)min,and the blood loss was(100±20)mL.Among them,the rate of I/A healing was 99.8％,dural tear rate was 4.0％,nerve root injury rate was 0.5％,and cerebrospinal fluid leakage rate was 0.9％.The incidence of complications in the cases after 2000 was significantly lower.Conclusion By summarizing the operation technique of posterior lumbar disc herniation,the operation error can be avoided and the incidence of complications of surgical injury can be reduced.