半侧椎板截取回植与开窗在腰椎间盘突出症髓核摘除术中的疗效比较

目的 :评价半侧椎板截取回植与开窗在治疗单侧腰椎间盘突出症中的临床疗效。方法 :对2012年5月至2014年8月收治的119例单侧腰椎间盘突出症患者的临床资料进行回顾性分析,男65例,女54例;年龄40~59岁,平均49.6岁。其中58例采用椎板开窗减压髓核摘除(开窗组),61例采用半侧椎板截取髓核摘除再回植(回植组),观察术中神经及硬膜囊损伤率、椎板愈合率、术后腰腿痛复发率,采用VAS及JOA评分比较两组疗效。结果:117例患者均获得1年以上随访,回植组、开窗组各失访1例。(1)回植组神经和硬膜囊损伤率(分别为3.33%和5.00%)与开窗组(分别为7.02%和8.77%)比较差异无统计学意义(P0.05);(2)术后1年回植组腰痛复发率为5.00%,低于开窗组的15.80%(P0.05);(3)术后1年两组的VAS、JOA评分比较差异有统计学意义(P0.05),回植组明显优于开窗组;(4)回植组CT显示椎板截骨部未达骨性愈合2例,椎板愈合率96.7%,未发现钛板、螺钉松动断裂。结论:半侧椎板截取回植手术设计更加合理,术野开阔既保证了脊柱的稳定性,又预防了硬膜粘连,减少了术后腰痛的复发,是一种安全、有效的新方法。

Efficacy evaluation of unilateral lamina osteotomy replantation versus fenestration in nucleus pulposus resection of lumbar disc herniation

Objective: To evaluate the clinical effects of unilateral lamina osteotomy replantation versus fenestration in the treatment of unilateral lumbar disc herniation. Methods: The clinical date of 119 patients with unilateral lumbar disc herniation underwent surgical treatment from May 2012 to August 2014 were retrospective analyzed. There were 64 males and 54 females, aged from 40 to 59 years old with an average of 49.6 years. Among them, 58 patients were treated with lamina fenestration and decompression and nucleus pulposus resection(fenestration group);61 patients were treated with unilateral lamina osteotomy and replantation after nucleus pulposus resection (replantation group). The incidence rate of nerve and dural injury during operation, lamina healing rate, the recurrent rates of postoperative low back and leg pain were observed. According to the standard of JOA score, the clinical effects was compared between two groups. Results: A hundred and seventeen patients were followed up more than 1 year, each group 1 case was lost to follow-up. The injury rate of nerve and dural was 3.33%, 5.00% respectively in replantation group, while 7.02%, 8.77% respectively in fenestration group, there was no significant differences between two groups(P > 0.05). One year after operation, there was significant difference in the recurrent rate of low back pain and JOA, VAS scores between two groups, replantation group was better than that of fenestration group(P < 0.05). CT showed the osteotomy of 2 cases had not obtained bone healing in replantation group with lamina healing rate of 96.7%, no loosening or breakage of titanium plates and screws were found. Conclusion: The design of unilateral lamina osteotomy replantation is more reasonable. Widen surgical vision not only guarantee the spinal stability, but also prevent epidural adhesion, which reduce the lower back and leg pain recurrence. It is a safe and effective new approach to treat lumbar disc herniation.