不采用术中X线定位的后路椎间盘镜髓核摘除术治疗腰椎间盘突出症

目的探讨后路椎间盘镜手术中不采用X线定位的可行性。方法269例腰椎间盘突出症患者行后路椎间盘镜髓核摘除术,不采用X线进行术中定位。根据术前腰椎平片,通过骨性标志的触摸和术中细针穿刺确定手术间隙并建立工作通道,术中可根据手术情况适当调整工作通道位置。结果手术时间30～90min,269例患者中,267例首次置入工作通道定位准确,2例术中发现定位错误（神经根松弛无间盘突出）,移动工作通道完成手术,无需重新切口。术后所有患者腰腿痛症状消失或缓解,复查X线照片未发现手术节段错误。并发马尾神经损伤1例,单纯脑脊液漏4例,切口愈合不良2例。结论参照腰椎平片,通过骨性标志的仔细触摸和术中细针穿刺定位,不采用术中X线定位的后路腰椎间盘镜手术确实可行,并节省术中定位时间,避免患者和医护人员的射线接触。

Microendoscopic discetomy for lumbar intervertebral disc protrusion with no intro-operative fluoroscopy guiding

[Objective] To dissuss the feasibility of performing microendoscopic discectomy without Intro-operative fluoroscopy guiding. [Methods] 269 patients were managed by means of microendoscopic discectomy. The level of appropriate disc space was located by means of anatomical landmark palpation and needle puncture. With no Intro-operative fluoroscopy monitoring, the tubular retractor was located at appropriate place and could be adjusted with respect to lamina. [Results] The operating time was 30~90 minutes. There were no final mistakes of disc space localization verified by post-operative radiograph. Localization of the disc space level were perfect in 267 cases. The 2 mis-located situation were found during procedure and successfully adjusted by the tubular retractor. There were no severe complications. Only 1 case of mild cauda equina injury, 4 cases of cerebrospinal fluid leakage and 2 cases of poor incision healing were found. [Conclusions] Microendoscopic discectomy can be performed successfully with no intro-operative fluoroscopy guiding, which saves operating time and avoids roentgen exposure of medical staff and patients.