显微内窥镜下手术治疗腰椎椎体后缘离断症

摘要

Objective To discuss effective operative method for posterior edge separation of lumbar vertebral body. Methods 26 cases of posterior edge separation of lumbar vertebral body were categorized as lateral type and central type, and were operated upon with microendoscopic surgery from Mar 2004 to Sep 2009. In lateral type cases, bony edge were in the posterolateral lower rim of L4 vertebral body in 2 case, in the posterolateral upper rim of L5 vertebral body in 8 cases and in the posterolateral upper rim of S1 vertebral body in 12 cases, all with ipsilateral disc herniation. All lateral type cases were operated upon through unilateral approach, and in a sequence of enlargement of nerve root cananl, removal of disc polpsus and posterior bony edge. Bony edge were in the central upper rim of S1 vertebral body with central disc herniation in 4 central type cases. 4 central type cases were operated upon through bilateral approaches, with enlargement of nerve root cananl and central canal, and with removal of disc polpsus and posterior bony edge. Results All patients were followed up 19 to 84 months, and mean follow-up time was 42.5 months. According to Macnab' s postoperative evaluation criterion, the operative result of microendoscopic surgery was evaluated as excellent in 20 cases, good in 6 cases. Conclusion Microendoscopic surgery for posterior edge separation of lumbar vertebral body has characteristic of less trauma and less destruction of the posterior structure of lumbar spine. It is an effective operation to remove posterior bony edge and disc polpsus, and decreases the possibility of lumbar instability.%目的 探讨腰椎椎体后缘离断症的有效手术方法.方法 2004年3月～2009年9月采用显微内窥镜手术治疗腰椎椎体后缘离断症26例,将其分为侧方型及中央型.侧方型22例,其中离断骨块位于L4椎体后下缘2例,L5椎体后上缘8例,S1椎体后上缘12例,均合并同侧椎间盘突出.中央型4例,离断骨块均位于S1椎体后上缘中央.侧方型采用单侧入路,按照扩大神经根管,摘除突出椎间盘髓核及椎体后缘离断骨块顺序进行手术;中央型采用双侧入路,扩大神经根管及中央椎管,摘除突出椎间盘髓核及椎体后缘骨块.结果 所有患者随访19～84个月,平均42.5个月,按照Macnab术后评定标准:优20例,良6例.结论 显微内窥镜手术治疗腰椎椎体后缘离断症具有创伤小,对腰椎后结构破坏少的优点,可有效摘除椎体后缘骨块及突出椎间盘,降低术后发生腰椎不稳的可能.