小切口开窗术治疗术后复发腰椎间盘突出症
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摘要
目的:探讨小切口椎板开窗髓核摘除术治疗术后复发腰椎间盘突出症的方法和临床疗效。
材料与方法:抽取2007年3月至2008年3月在辽宁省中医院骨二病房住院治疗的术后复发腰椎间盘突出症患者16例作为研究对象,根据病情行小切口开窗术治疗,采用常规腰椎间盘手术器械,取后正中纵形切口,在棘突旁椎板间开窗,并行神经根管减压,摘除髓核组织,手术时间30～90min,平均1h,其中腰4～5 6例,腰5骶1 4例,腰3～4 1例,腰4～5和腰5骶1双突出4例,腰3～4和腰4～5双突出1例,并按日本矫形外科协会(JOA)评分系统进行评分,对术后神经功能恢复进行评价。
结果:小切口有限骶棘肌剥离和开窗法,遵循外科微创技术行腰椎髓核摘除术。术后随访6个月～18年,平均12个月,根据JoA评定标准,优10例,良5例,可1例,差0例,有效率100%,优良率为93.8%,无1例再复发者。JOA评分由术前平均11.8分上升至术后24.5分。本组无神经根损伤,2例硬脊膜撕裂,均修复,伤口一期愈合,腰腿痛症状消失。
结论:小切口椎板间开窗髓核摘除术是治疗术后复发腰椎间盘突出症的有效方法之一。
Purpose:To discuss the medical effect and the surgery method of small incision for the treatment of recrudescent lumbar disc herniation(LDH)。
Material and method:Random sample of 16 cases of patients who recrudescent LDH after surgery form March 2007 to March 2008 were subjected to operations with conventional surgical instruments.A posterior central mini-incision was made.The whole operative time was 30 min to 1.5 h(mean 1 h).There were 6 cases of LDH in L4～5,4 cases LDH in segment L5～S1,1 cases LDH in segment L3～4,both L4～5 and L5～S1 were 4 cases and 1 case was found in both L4～5 and L3～4.According to the JOA criteria,evaluate the nerve recovery rate after operation。
Results:All the patients were followed up for 6 months to 18 months(mean 12 months).According to the JOA criteria,the outcome was excellent in 10 cases, good in 5 cases,fair in 1 cases and poor in 0 cases.The excellent good rate was 93.8%.The score of JOA were mean 11.8,increase to mean 24.5 after operation.All the cases was no injury of nerves and spinal cord.All the patients' symptom of pain of waist and leg were cured。
Conclusion:The method of small incision technique is the effective way for the treatment of recrudescent Lumbar prolapsed vertebral disc。
材料与方法:抽取2007年3月至2008年3月在辽宁省中医院骨二病房住院治疗的术后复发腰椎间盘突出症患者16例作为研究对象,根据病情行小切口开窗术治疗,采用常规腰椎间盘手术器械,取后正中纵形切口,在棘突旁椎板间开窗,并行神经根管减压,摘除髓核组织,手术时间30～90min,平均1h,其中腰4～5 6例,腰5骶1 4例,腰3～4 1例,腰4～5和腰5骶1双突出4例,腰3～4和腰4～5双突出1例,并按日本矫形外科协会(JOA)评分系统进行评分,对术后神经功能恢复进行评价。
结果:小切口有限骶棘肌剥离和开窗法,遵循外科微创技术行腰椎髓核摘除术。术后随访6个月～18年,平均12个月,根据JoA评定标准,优10例,良5例,可1例,差0例,有效率100%,优良率为93.8%,无1例再复发者。JOA评分由术前平均11.8分上升至术后24.5分。本组无神经根损伤,2例硬脊膜撕裂,均修复,伤口一期愈合,腰腿痛症状消失。
结论:小切口椎板间开窗髓核摘除术是治疗术后复发腰椎间盘突出症的有效方法之一。
Purpose:To discuss the medical effect and the surgery method of small incision for the treatment of recrudescent lumbar disc herniation(LDH)。
Material and method:Random sample of 16 cases of patients who recrudescent LDH after surgery form March 2007 to March 2008 were subjected to operations with conventional surgical instruments.A posterior central mini-incision was made.The whole operative time was 30 min to 1.5 h(mean 1 h).There were 6 cases of LDH in L4～5,4 cases LDH in segment L5～S1,1 cases LDH in segment L3～4,both L4～5 and L5～S1 were 4 cases and 1 case was found in both L4～5 and L3～4.According to the JOA criteria,evaluate the nerve recovery rate after operation。
Results:All the patients were followed up for 6 months to 18 months(mean 12 months).According to the JOA criteria,the outcome was excellent in 10 cases, good in 5 cases,fair in 1 cases and poor in 0 cases.The excellent good rate was 93.8%.The score of JOA were mean 11.8,increase to mean 24.5 after operation.All the cases was no injury of nerves and spinal cord.All the patients' symptom of pain of waist and leg were cured。
Conclusion:The method of small incision technique is the effective way for the treatment of recrudescent Lumbar prolapsed vertebral disc。
引文
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4.洪德胜,周涛。攻下逐瘀法治疗腰椎间盘突出症50例.中医正骨,2000,12(3):60
5.张姚萍,周军.麻痹止痛汤加减治疗腰椎间盘突出症61例报告.中医正骨,2000,12(6):41
6.陈爱萍.金鹿固肾汤治疗腰椎间盘突出症120例报告.中医正骨,2000,12(9):47
7.王万霞,李国桥,顾月兰。腰痛Ⅰ号治疗腰椎间盘摘除术后腰腿痛32例疗效观察.中医正骨,2001,13(12):5
8.程友昌.腰痛活血方治疗腰椎间盘摘除术后腰腿痛34例疗效观察.中医正骨,2002,14(5):23
9.张继元.骨痛膏治疗腰椎间盘突出症184例临床观察.中医正骨,2001,13(9):47
10.张维斌,王佳福,王春生,等.β-七叶皂试钠配合地塞米松治疗腰椎间突出症67例[J].颈腰痛杂志,2001,22(1):371
11.陈钢,汤军燕,杨沛群,等.自制骨盆牵引架半体重仰角牵引疗法治疗腰椎间盘突出症疗效观察.中医正骨,2000,12(12):16
12.葛清叶,韩文朝,郭迪.前屈俯卧位牵引下推拿治疗腰椎间盘突出症.中医正骨,2000,12(12):27
13.潭福泉,蔡宏华,程国强,等三维牵引加手法复位治疗腰椎间盘突出症82例报告.中医正骨,2000,12(9):49
14.王福根,高谦,毕胜,等.腰椎间盘突出症临床治疗机制探讨[J].中国临床康复,2003,7(8):1320
15.师彬,王吉荣,王玉珍.手法为主综合治疗腰椎间盘突出症275例[J].针灸推拿,2003,22(1):26-27
16.韩德韬,施能木,张昌茂,等.暴力推拿所致急重型腰椎间盘突出症18例分析[J].骨与关节损伤杂志,1998,13(5):292-293
17.蒋会平,王泽强,吴建华,等.从腰椎间盘手术认识重手法推拿利弊[J].颈腰痛杂志,1995,16(2):97-98
18.沈克艰.排针深刺治疗腰椎间盘突出症临床检查.中国针灸,2000,20(11):651
19.李昌生.浮针治疗腰椎间盘突出症疗效观察.中国针灸,2001,21(9):529
20.王炫京,王小平,王炫逊,等.药针治疗腰椎间盘突出症43例.中国针灸,2002,22(2):85
21.蒋丽霞.小针刀治疗腰椎间盘突出症80例分析.中医正骨,2002,14(8):26
22.陈明涛,刑随群.小针刀治疗腰椎间盘突出症疗效观察.中医正骨,2002,14(5):41
23.胡有谷.腰椎间盘突出症[M].北京:人民卫生出版社.1985,221
24.支满霞,陈力夯.硬膜外腔注射药物治疗腰椎间盘突出症中B族维生素所起作用[J].中国疼痛医学杂志,1995,1:87-88
25.李佛保.硬膜外封闭治疗腰腿痛机理探讨[J].新医学.1985.16:400-401
26.王永江,余雷,邹清远.应用硬膜外充填法治疗腰腿痛分析[J].中华麻醉学杂志,1988,8[1]:111-112
27.赵俊.硬膜外药物镇痛作用的机理探讨[J].中华麻醉杂志,疼痛治疗专刊,1989,4
28.毕强,候毅鞠,郭素红,等.腰椎间盘突出症治疗前后血清β-内啡肤含量变化[J].空军医高专学报,1999,21(2):103-104
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