| 高位腰椎间盘突出症的解剖学特点及术式选择 |
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投稿时间：2015-11-18
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| 作者 | Author | 单位 | Address | E-Mail |
| 梁成民 |
LINAG Cheng-min |
阜阳市人民医院骨科, 安徽 阜阳 234000 |
Department of Orthopaedics, People's Hospital of Fuyang, Fuyang 234000, Anhui, China |
liangchm@163.com |
| 崔西龙 |
CUI Xi-long |
阜阳市人民医院骨科, 安徽 阜阳 234000 |
Department of Orthopaedics, People's Hospital of Fuyang, Fuyang 234000, Anhui, China |
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| 于海洋 |
YU Hai-yang |
阜阳市人民医院骨科, 安徽 阜阳 234000 |
Department of Orthopaedics, People's Hospital of Fuyang, Fuyang 234000, Anhui, China |
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| 焦伟 |
JIAO Wei |
阜阳市人民医院骨科, 安徽 阜阳 234000 |
Department of Orthopaedics, People's Hospital of Fuyang, Fuyang 234000, Anhui, China |
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| 翟云雷 |
ZHAI Yun-lei |
阜阳市人民医院骨科, 安徽 阜阳 234000 |
Department of Orthopaedics, People's Hospital of Fuyang, Fuyang 234000, Anhui, China |
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| 期刊信息：《中国骨伤》2016年，第29卷，第7期，第640-644页 |
| DOI：10.3969/j.issn.1003-0034.2016.07.011 |
| 基金项目: |
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中文摘要:
目的：探讨不同节段高位腰椎间盘突出症的解剖学特点及手术方式的选择，评价其疗效。
方法：自2009年1月至2013年1月，收治26例单间隙高位腰椎间盘突出症患者，其中男16例，女10例；年龄28~51岁，平均45.7岁；L1,2 4例，L2,3 9例，L3,4 13例。术中对下关节突外缘至棘突根部距离，峡部外缘至棘突根部的距离，椎板下缘至椎间隙上缘距离，神经根起点至上一椎间盘下缘的垂直距离及神经根起点至相应椎弓根内下缘的距离进行测量。对于L1,2、L2,3 椎间盘突出症及L3,4 椎间盘突出症合并腰椎不稳患者（5例）实施改良经椎间孔椎间盘切除椎间植骨椎弓根螺钉内固定术治疗；L3,4 椎间盘突出症患者（8例）实施后路开窗减压术治疗。采用日本骨科学会（Japanese Orthopaedic Association,JOA）（29分）评分法评估手术疗效，计算改善率，测量术前、术后1年随访时椎间隙相对高度（R）,观察植骨融合情况。
结果：所有患者在术中进行解剖学测量。术后均获得1年以上的随访，平均16个月，切口均愈合，JOA评分由术前10.13±1.49提高到25.21±2.13,改善率为79.9%.实施融合术患者无内固定失败，1例可能不融合，17例骨性融合，术前R为（0.231±0.056） mm,随访时（0.345±0.076） mm,较术前椎间隙相对高度增高 （P < 0.05）;实施后路开窗减压术治疗患者，术前R为（0.243±0.036） mm,随访时（0.212±0.046） mm,术前及随访时椎间隙相对高度差异无统计学意义（P > 0.05）,未发生节段性腰椎不稳及椎间盘突出复发。
结论：L1,2、L2,3 椎间盘突出症由于解剖学特点，适合行改良经椎间孔椎间盘切除椎间植骨椎弓根螺钉内固定术治疗；L3,4 椎间盘突出症其解剖学及临床特点接近于下腰椎间盘突出的特点，应根据术前对腰椎稳定性的判断来选择手术方法。 |
| 【关键词】高位腰椎间盘突出症 解剖学特点 经椎间孔腰椎间融合术 开窗减压术 |
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| Anatomical characteristics and surgical selections of upper lumbar disc herniation |
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ABSTRACT
Objective: To explore the anatomical characteristics and surgical selections of upper lumbar disc herniation, and evaluate its clinical effects.
Methods: From January 2009 to January 2013, 26 patients with upper lumbar disc herniation were treated in our department. There were 16 males and 10 females, aged from 28 to 51 years old with an average of 45.7 years, 4 cases were in L1, 2, 9 cases in L2, 3, and 13 cases in L3, 4. The data was collected including distance between outer edge of lower facet and the spinous process, the outer edge of the isthmus and spinous process, the lower edge of lamina and the upper edge of the intervertebral space, nerve root arising points and lower edge of the corresponding pedicle. Transforaminal discectomy and interbody fusion combined with pedicle screw fixation was performed in patients with L1, 2, L2, 3 herniated disk and 5 patients with L3, 4 herniated disk complicated with lumbar instability. However another 8 patients with L3, 4 herniated disk were treated with posterior fenestration decompression. Clinical effects were evaluated by Japanese Orthopaedic Association(JOA). The relative height rate(R) of the intervertebral space was measured preoperatively and 1 year postoperatively. The fusion of the bone graft was also observed.
Results: Intraoperative anatomical measurement was taken in all patients. All patients were followed up for more than 1 year with an average of 16 months, and all incisions got healing, JOA was improved from preoperative(10.13±1.49) points to last follow-up (25.21±2.13) points with the improvement rate of 79.9%. Among the patients underwent fusion operation, 17 cases obtained bone fusion and 1 case maybe non-fusion and no internal fixation failure was found;the R value was (0.231±0.056) mm preoperatively, however (0.345±0.076) mm at 1 year after operation with statistical difference(P < 0.05). In the patient underwent posterior fenestration decompression, the R value was(0.243±0.036) mm preoperatively, and (0.212±0.046) mm at 1 year after operation without statistical difference (P > 0.05). No spinal instability and lumbar disc herniation recurrence were found in these patients.
Conclusion: According to the anatomical characteristics of L1, 2 and L2, 3 herniated disk, these patients could be treated with transforaminal discectomy and interbody fusion. The anatomical characteristics and clinical manifestations of L3, 4 herniated disk is similar with the lower lumbar disc herniation, for the patients, an appropriate surgical method should be chosen according to the lumbar stability. |
| KEY WORDS Upper lumbar disc herniation Anatomical characteristics Transforaminal lumbar interbody fusion Fenestration decompression |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 梁成民,崔西龙,于海洋,焦伟,翟云雷.高位腰椎间盘突出症的解剖学特点及术式选择[J].中国骨伤,2016,29(7):640~644 |
| 英文格式: | LINAG Cheng-min,CUI Xi-long,YU Hai-yang,JIAO Wei,ZHAI Yun-lei.Anatomical characteristics and surgical selections of upper lumbar disc herniation[J].zhongguo gu shang / China J Orthop Trauma ,2016,29(7):640~644 |
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