术前精确神经定位间盘镜手术治疗腰椎间盘突出症

目的探讨应用影像方法术前精确神经定位间盘镜手术（MED）手术的安全有效性。方法回顾性分析采用MED方法治疗腰椎间盘突出症的病例87例,其中男54例,女33例,85例进行了CTM检查,11例进行了CTD检查,2例进行了神经根造影及封闭术。从JOA评分、Odom’s标准、NAPS、术后下地活动及生活自理时间、手术切口大小、手术时间及出血量等方面进行疗效观察。结果JOA评分术前（18．2±3．3）分,随访（23．8±4．6）分,JOA改善率（58．7±4．2）％。按Odom’s标准：优59例,良26例,可3例,差1例。优良率95．5％。下腰痛NAPS评分术前（1．8±0．4）分,随访评分（1．7±0．3）分,P=0．607。术后下地活动时间（2．38±0．21）d,生活自理时间（12．1±2．2）d,手术切口大小（1．86±0．04）cm,手术时间（72．2±12．4）min,出血量（47．5±4．6）ml。结论MED术前应用造影方法精确定位责任间隙及神经根,可以明显减低术中神经损伤的风险,缩短手术时间,减少术中出血,提高术后疗效,使镜下手术扬长避短发挥优势,是一种值得推荐的方法。

Accurate nerve orientation before micro endoscopic discectomy for lumber disc prolapse

OBJECTIVE: To assess the safety and efficiency of using computerized tomography myelography (CTM) and computerized tomography discography (CTD) to accurately orientate the nerve before microendoscopic discectomy (MED). METHOD: Eighty-seven patients with lumber disc prolapse, 54 males and 33 females, aged 35.6 +/- 3.0, underwent MED. Before operation, 85 patients underwent CTM, 11 patients underwent CTD, and 2 were treated with nerve root opacification and blockade. The effects, including the rate of improved JOA score (RIS), numerical analogous pain score (NAPS) of low back, Odom's standard, blood loss during operation, start walking time, etc. were observed. RESULTS: The JOA score was 18.2 +/- 3.3 before operation, and increased to 23.8 +/- 4.6 during the follow-up, with a JOA improvement rate of 58.7% +/- 4.2%. According to the Odom's standard, the outcome was excellent in 59 cases, good in 26 cases, OK in 3 cases, and poor in 1 case, with an excellence rate of 95.5%. The value of NAPS was 1.8 +/- 0.4 before operation, not significantly different from that during follow-up (1.7 +/- 0.3, P = 0.607). The average start walking time after operation was (2.38 +/- 0.21) days, the average recovery time was (12.1 +/- 2.2) days, the incision size was (1.86 +/- 0.04) cm, the surgical time was (72.2 +/- 12.4) min, and the average blood loss during operation was (47.5 +/- 4.6) ml. CONCLUSION: Using CTM and CTD to accurately orientate the diseased disc and nerve root before MED decreases the possibility of nerve damage, operation time and blood loss during operation, and improves the outcomes, so it is recommendable.