Postacchini F, Cinotti G, Gumina S
Clinica Ortopedica, University of Rome La Sapienza, Italy.
J Bone Joint Surg Br. 1998 Mar;80(2):201-7. doi: 10.1302/0301-620x.80b2.8163.
We made a prospective study of 43 consecutive patients treated for intraforaminal (34) or extraforaminal (9) herniations of a lumbar disc by excision through an interlaminar approach, using an operating microscope. The intraforaminal herniations were contained or extruded in 52% and sequestrated in 47%; for extraforaminal herniation the proportions were 66% and 33%, respectively. There was additional posterolateral protrusion or spinal stenosis at the level of the lateral herniation in seven and four cases, respectively. The patients were reviewed at three months and two years after surgery. Radiographs showed three grades of facetectomy: grade I, removal of 50% or less, grade II, excision of 51% to 75%, and grade III, subtotal or total facetectomy. For intraforaminal herniations the results were excellent or good in 88% of patients when reviewed at three months and in 91% at two years. For extraforaminal herniations, there was an excellent or good outcome in 89% of patients in the short term and in all in the long term. The facetectomy had been grade I in 14 and grade II in 25; it had been grade III in four, but only one had had total facetectomy. No patient had developed vertebral hypermobility as a result of the operation. An intralaminar approach using an operating microscope can provide adequate access to a lateral protrusion. It has the advantage of allowing the treatment of posterolateral protrusion or posterior annular bulge and of spinal stenosis at the same level.
我们对43例连续接受治疗的患者进行了前瞻性研究，这些患者均通过椎板间入路，使用手术显微镜切除腰椎间盘椎间孔内（34例）或椎间孔外（9例）突出物。椎间孔内突出物中，包容性或脱出性占52%，游离性占47%；椎间孔外突出物中，这两个比例分别为66%和33%。分别有7例和4例在外侧突出水平伴有额外的后外侧突出或椎管狭窄。对患者在术后3个月和2年进行复查。X线片显示三种椎板切除分级：I级，切除50%或更少；II级，切除51%至75%；III级，次全或全椎板切除。对于椎间孔内突出，术后3个月复查时88%的患者结果为优或良，2年时为91%。对于椎间孔外突出，短期内89%的患者结果为优或良，长期来看所有患者结果均为优或良。椎板切除分级为I级的有14例，II级的有25例；III级的有4例，但只有1例进行了全椎板切除。没有患者因手术出现椎体活动度增加。使用手术显微镜的椎板内入路能够为外侧突出提供足够的显露。它具有能够同时治疗后外侧突出或后纵环行膨出以及同一水平椎管狭窄的优点。
