显微内窥镜下行腰椎间盘手术治疗的疗效探讨

目的总结后路显微内窥镜下椎间盘切除术（MED）治疗腰椎间盘突出症疗效，探索其操作要领。方法2002年6月至2006年10月对66例腰椎间盘突出患者采用MED治疗，术中用C臂X线定位，建立工作通道，在显微内窥镜下切除部分椎板、黄韧带及少量关节突内缘，牵开硬膜与神经根，显露突出的纤维环和髓核、切除髓核。减压神经根管，松解神经根。采用MacNab腰椎评价标准评价疗效。结果患者术后平均3d下地活动，平均住院时间8d。平均17d生活自理，5周恢复工作。平均随防时间32个月，优41例（62．1％），良23例（34．8％），优良率97．0％。硬脊膜破裂2例，神经根挫伤1例。结论后路MED手术创伤小，术后卧床时间短，恢复快，可取得与开窗手术相近的疗效。不影响腰椎的稳定性，但需不断学习，掌握其要点才能熟练操作。

The dinical analyze of microendoscopic discectomy for lumbar disc protrusion

Objective To investigate the clinical effect of microendoscopic discectomy for lumbar disc protrusion.Methods 66 cases with lumbar disc protrusion were treated with microendoscopic discectomy in our hospital from June 2002 to October 2006,and their clinical effect were analyzed retrospectively with MacNab lumbar evaluation criterion.Results The average stay was 8 days,and the fine ratio Wag 97.0%;all patients retun to work postoperative 5 days;2 case was complicated by ruptured dura mate of spinal cord,1 cage was complicated by nerve root contund.Conclusion The surgical trauma of microendoscopic discectomy for lumbar disc protrusion wag small.its' clinical effect was as good as fenestration operation.