伊力夏提+张宁++刘波

[摘要] 目的 探討椎板间开窗腰椎间盘髓核摘除术（LOVE）切除离断骨块对腰椎间盘突出（LDH）伴椎体后缘离断的治疗效果。 方法 回顾性分析2013年1月～2014年1月于北京积水潭医院就诊的LDH伴椎体后缘离断行改良LOVE治疗，且离断骨块未对神经根造成明显压迫的患者56例，其中单纯髓核摘除组（实验组）26例患者只切除了突出的椎间盘组织，未对离断骨块进行处理；骨块切除组（对照组）30例患者除了切除突出的椎间盘组织，还对离断的骨块进行了部分或完全切除。所有的患者术后至少随访2年。记录两组患者手术时间，术中出血量，术前、术后JOA评分、VAS及术中、术后并发症的发生情况。 结果 实验组手术时间明显短于对照组（P < 0.01），术中失血量明显少于对照组（P < 0.01）。两组不同时点VAS组间比较，差异无统计学意义（P > 0.05）。两组不同时点VAS组内比较，差异有高度统计学意义（P < 0.01）。两组不同时点JOA评分组间比较，差异无统计学意义（P > 0.05）。两组不同时点JOA评分组内比较，差异有高度统计学意义（P < 0.01）。两组术后3个月、1年及2年疗效比较，差异无统计学意义（P > 0.05）。两组患者在术后2年随访周期内均未见症状复发，均未出现并发症。 结论 LDH伴椎体后缘离断，离断骨块未对神经根造成明显压迫的患者使用改良LOVE治疗不处理离断骨块，与切除离断骨块比较，同样能达到良好的治疗效果，并缩短了手术时间，减少了术中失血量。

[关键词] 腰椎间盘突出；椎体后缘离断；髓核摘除术；治疗效果

[中图分类号] R681.5 [文献标识码] A [文章编号] 1673-7210（2017）07（b）-0176-05

The curative effect of denervated bone resection combined with lamina fenestration and nucleotomy on lumbar disc herniation with the posterior vertebral body amputation

Yilixiati ZHANG Ning LIU Bo

Department of Spine Surgery， Beijing Jishuitan Hospital， Beijing 100035， China

[Abstract] Objective To investigate the curative effect of denervated bone resection combined with lamina fenestration and nucleotomy （LOVE） on lumbar disc herniation （LDH） with the posterior vertebral body amputation. Methods From January 2013 to January 2014， patients treated in Beijing Jishuitan Hospital who had LDH with posterior edge separation were retrospectively analyzed. All patients underwent modified LOVE procedure. 56 patients had no nerve root compression by the posterior denervated bony. 56 patients were divided into two groups： trial group， 26 patients only underwent nucleotomy without resection of the posterior denervatied bony； and control group， 30 patients underwent nucleotomy with resection of the posterior denervated bony. All patients were followed up at least for 2 years. The operating time， intraoperative blood loss， preoperative and postoperative JOA score， VAS and intraoperative and postoperative complications between two groups were recorded. Results The operating time of trial group was significantly shorter than that of control group （P < 0.01）. The blood loss of trial group was significantly less than that of control group （P < 0.01）. There was no significant difference on VAS between two groups at different time points between groups （P > 0.05）. There was a statistically significant difference on VAS between two groups at different time points in the group （P < 0.01）. There was no significant difference on JOA score between two groups at different time points between groups （P > 0.05）. There was a statistically significant difference on JOA score between two groups at different time points in the group （P < 0.01）. There were no significant differences on curative effect between two groups after 3 months， 1 year and 2 years （P > 0.05）. Patients of two groups in 2-year follow-up cycle were no symptoms recurrence， no complications. Conclusion Modified LOVE in the treatment of LDH with vertebral fracture of the posterior margin， if the denervated bone hasn′t caused significant nerve root compression， neglect of denervated bone can achieve the same good curative effect， and can shorten operation time， reduce intraoperative blood loss compared with denervated bone resection.

[Key words] Lumbar disc herniation； Vertebral posterior margin； Removal of nucleus pulposus； Curative effect

腰椎间盘突出（LDH）是脊柱外科最常见的疾病之一，是指腰椎间盘纤维环因退变或外伤发生裂隙，在外力作用下，使髓核等椎间盘组织向后或后外方膨出或突出，刺激、压迫神经根，进而导致神经根炎症、营养障碍和传导性损害的一类疾病，常引起腰腿痛及间歇性跛行等症状，严重影响患者的工作和生活[1-4]。……