后路椎间隙微创手术治疗腰椎间盘突出症

目的:探讨后路椎间隙微创手术治疗腰椎间盘突出症的方法和疗效,进一步规范其适应证。方法:腰椎间盘突出症患者132例,男87例,女45例;年龄21～69岁,平均41岁。采用后路椎间隙显微镜下手术治疗,分析上位椎板下缘咬除范围、术中出血量、手术时间及术后疗效。结果:L5S12例咬除L5椎板下缘2.0mm,余未行椎板咬除;L4,5咬除L4椎板下缘范围5～9mm,平均7.0mm;L3,4咬除L3椎板下缘范围8～10mm,平均9.6mm。术中平均出血量60ml,平均手术时间50min。术后以Macnnab标准评价:优82例,良44例,可6例,优良率95.5%。结论:后路椎间隙微创手术治疗腰椎间盘突出症,对软组织骨性结构破坏小,适用于单节段腰椎间盘突出合并神经根管狭窄、后纵韧带骨化患者。

Treatment of lumbar intervertebral disc herniation with minimally invasive discetomy through inter-laminar space of posterior approach

Objective:To explore the effect and method of minimally invasive discectomy through inter-laminar space of posterior approach in treating lumbar intervertebral disc herniation and clarify its indication.Methods:A hundred thirty-two patients(87 mals and 45 femals) of lumbar disc herniation aged from 21 to 69 years old(mean 41 years) were treated with minimally invasive discectomy in microscope through inter-laminar space of posterior approach.Resected range in lower margin of superior lamina,bleeding during operation,operative time and postoperative effect were analyzed.Results:The vertebrae were not resected in L5S1 except in 2 cases resected 2 mm;resected range from 5 to 9 mm(mean 7.0 mm)in L4,5;from 8 to 10 mm(mean 9.6 mm)in L3,4.The mean bleeding was 60 ml during operation and the mean operative time was 50 min.According to standard of Macnnab,82 cases obtained excellent results,44 good,6 fair,the percentage of excellent and good was 95.5%.Conclusion:Minimally invasive discectomy through inter-laminar space of posterior approach have less demolition for soft tissue and osseous structure,indicated to one-level lumbar intervertebral disc herniation combined with nerve root canal stenosis and ossification of posterior longitudinal ligament.