后路减压植骨融合内固定术治疗高位腰椎间盘突出症_临床医学论文.docVIP

后路减压植骨融合内固定术治疗高位腰椎间盘突出症_临床医学论文 后路减压植骨融合内固定术治疗高位腰椎间盘突出症_临床医学论文 作者：丁文元，关晓明，董玉昌，申勇，张为，吴涛，高飞 【摘要】 ［目的］ 探讨后路减压植骨融合内固定术治疗高位腰椎间盘突出症的临床疗效。［方法］ 对26例高位腰椎间盘突出症患者行后路减压植骨融合内固定手术治疗，术前进行腰痛VAS及腰腿痛评分，术后平均随访20.8个月（8个月～3年），末次随访时进行VAS评分及腰腿痛评分，通过配对比较t检验，比较术前及术后VAS及腰腿痛功能评分。［结果］26例患者全部获得随访，术后VAS评分较术前明显减少，（P＜0.05）；术后腰腿痛评分较术前明显增加，下肢功能明显改善，（P＜0.05）。本组22例获得优良手术效果，优良率为84.6%。［结论］后路减压植骨融合内固定治疗高位腰椎间盘突出症是一种切实可行的手术治疗方式，手术疗效明确。术中操作轻柔、仔细，避免医源性损伤是手术成功的关键。 【关键词】 高位椎间盘突出症； 手术治疗； 诊断； 疗效 Abstract: ［Objective］To evaluate the effectiveness of posterior lumbar interbody fusion (PLIF) in the treatment of upper lumbar disc herniation. ［Method］Twenty six patients of upper lumbar disc herniation underwent posterior lumbar interbody fusion, lumbago VAS and the pain in waist and lower extremities grades were tested before operation, all patients had an average follow-up period of 20.8 months，then lumbago VAS and the pain in waist and lower extremities grades were tested at last follow-up, lumbago VAS and the pain in waist and lower extremities grades were compared through paired t-test.［Result］All 26 patients had a followed-up.Postoperative VAS had significant lower than preoperative, statistical analysis has remarkable significance（P＜0.03）, the pain in waist and lower extremities grades had significantly improved；the function of lower extremities had distinct improvement , statistical analysis has remarkable significance（P＜0.02）.Twenty-two patients had satisfactory operation results, with excellent and good ratio of 84.6%.［Conclusion］Posterior lumbar interbody fusion is a feasible operation to upper lumbar disc herniation ,with significant therapeutic effect.Gentle and careful operation, and avoiding the medical inijury is the key to insure suecess of the surgery. Key words：upper lumbar disc herniation； surgery； diagnosis； therapeutic effect 高位腰椎间盘突出症是指突出部位位于L3、4及其以上的椎间隙的椎间盘突出压迫神经而导致的疾患。因其发病率低，临床症状复杂，误诊率、漏诊率高达30%～40%。目前由于MRI的普及，其确诊率明显增高。对于高位腰椎间盘突出症采取何种手术方式，是否行内固定融合及稳定活动异常的运动节段，目前还没有定论。本院自2003年1月～2006年4月收治26例高