椎间盘镜手术系统治疗腰椎间盘突出症的临床探讨

目的探讨椎间盘镜手术系统（MED）治疗腰椎间盘突出症的手术方法和临床疗效。方法腰椎间盘突出症患者60例，常规内镜操作下显露腰椎板间隙，用微型手术刀切开并剥离黄韧带，用神经根拉钩将神经根拉向内侧以充分显露突出的腰椎间盘，椎间盘摘除和神经根松解后将黄韧带瓣恢复到原来解剖部位。结果60例手术顺利，无中转开放手术。手术时间40—80min，平均（50±12）min；切口均呈I／甲愈合，无任何并发症。60例随访9～16个月，平均12．8个月，疗效评定按Nakai疗效评定标准：优38例，良18例，可4例，差0例，优良率为93．33％。结论MED治疗腰椎间盘突出症手术操作安全，组织损伤轻，同时保持了脊柱的稳定性，而且能降低术后椎管内瘢痕粘连，临床疗效好。

Clinical study on treatment of lumbar disc herniation by microendoscopic discectomy

Objective To study surgical methods and clinical efficacy on treatment of lumbar disc herniation by microendoscopic discectomy. Methods A total of 60 patients with the lumbar disc herniation were enrolled in the study. The microscope endoscopic tubular retractor system was used to access the interlaminar space. The nerve root was retracted medially with a nerve root retractor to expose the herniated lumbar disc for performing the discectomy. The dissociative ligament was restored anatomically after disc removal and the decompression of the nerve root. Results The operation was completed smoothly in all the 60 patients, without conversions to open surgery. The operation time was （50 ± 12） rain （ range,40 - 80 min）. The wound healed by first intention in all the patients. No complications were observed. A follow - up was carried out for 9 - 16 months （ mean, 12.8 months）. According to the Nakai classification, excellent results were achieved in 38 patients, good in 18 patients,fair in 4 ,and poor in 0, the rate of excellent or good outcomes being 93.33%. Conclusions The treatment of lumbar disc herniation by microendoscopic discectomy is safe, with little organization damages, simultaneously maintained spinal columns stability. It is an effective way of preventing the scar after the operation of disc herniation, the clinical effect is good.