内窥镜后路下腰椎间盘切除术解剖与临床研究

目的：为显微内窥镜下腰椎间盘切除术提供解剖学基础,提高手术效果.方法：20具成人L3～S1段尸体标本,去除腰椎畸形凸出标本,正中矢状锯开,观测椎板、黄韧带、神经根与椎间盘之间关系.临床应用椎间盘镜（MED）治疗腰椎间盘突出56例.结果：L3～4椎间盘被L3椎板遮挡最多,L4～5椎间盘次之,而L5～S1椎间盘没有或仅有少许被L5椎板遮挡 L3～4椎间盘下缘均在L4神经根肩部上方,L4～5椎间盘下缘多在L5神经根肩部、腋部之间,而L5～S1椎间盘多在S1神经根腋部下方 临床随访5～8个月,根据NaKai分级,优46例,良9例,可1例.优良率98.2% .结论：严格把握适应证、熟练掌握腰椎各节段解剖特点,是提高MED手术成功率和减少并发症的关键.

Anatomy and Clinic of Posterior Endoscopic Lumbar Discectomy

Objective：To provide anatomical basis for microendoscopie lumbar diseeetomy and improve the treating result. Methods：The L3 - S1 Segments of 20 adult cadaver specimens （not including the abnormal protrusion of the lumbar spine） were sawed through median sagittal planes. The relationship belween lamina, ligamentum flavum, nerve roots and the intervertebral disc was investigaled. 56 eases of lumbar disc herniation with the clinical MED treatment and 5 - 8 months folluw - up after the operation in order to observe the curative effect. Results：The most blocked by L3 lamine（tomy was L3-4 Discectomy, L4-5 disc followed, while lhere was no or only some that was blocked by L5 laminectomy to the L5 - S1 disc ; the inferior margin of L3 4 disc＇ was a bove the shoulder of L4 nerve mot, the inferior margin nf L4-5 disc was sited between the shoulder and the axil of Ls nerve rnol. The L5 - S1 disc was at the bottom of axilla of SI nerve root; According to Nakai classification, among 56 cases of clinieal follow - up, the result was being excellent in 46 cases, being good in 9 cases, being fair in I case. The exeellent and good rate was 98.2%. Conclusions：The key point of increasing the sueeess rate of M ED surgery, and reducing complications is to strictly eontrol indication and master the different anatomical characteristics of various lumbar spine segments.