腰椎后路椎间盘镜术后5年疗效分析

目的：探讨腰椎后路椎间盘镜手术治疗腰椎间盘突出症的中期疗效。方法：腰椎间盘突出症患者117例,男63例,女54例;年龄24～72岁,平均50.6岁。单纯腰椎间盘突出症60例,单纯侧隐窝狭窄症10例,腰椎间盘突出症伴有侧隐窝狭窄32例,伴有髓核钙化15例。L3,42例,L4,556例,L5S148例,L4,5合并L5S111例。中央型22例,旁侧型95例。隆起型32例,破裂型73例,游离型12例。单侧98例,双侧19例。采用腰椎后路椎间盘镜椎间盘切除术（MED）对腰椎间盘突出症患者行髓核摘除和神经根管扩大。结果：117例经随访48～84个月,平均5.5年,根据中华骨科学会脊柱学组腰背痛手术评定标准：优93例,良16例,差8例。结论：严格掌握适应证、熟练的操作技术是减少MED手术并发症、提高疗效的关键。

Therapeutic effects of microendoscopic discectomy(MED) for the treatment of lumbar disc herniation with a follow-up of 5 years

Objective: To evaluate mid-term clinical results of microendoscopic discectomy(MED) for the treatment of lumbar disc hermiation. Methods: In the study,117 patients were reviewed,including 63 male and 54 female,ranging in age from 24 to 72 years,with an average of 50.6 years. Among the patients,60 patients had simple lumbar disc herniation,10 patients had simple lateral crypt stenosis,32 patients had lumbar disc herniation combined with lateral crypt stenosis,and 15 patients were combined with calcified nucleus pulposus. Two patients had herniation in L₃-L₄,56 patients in L₄-L₅,48 patients in L₅-S₁,11 patients in L₄-L₅ and L₅-S₁. The central type of lumbar disc herniation occurred in 22 patients and the lateral type of herniation occurred in other 95 patients. The Protrusion type of herniation occurred in 32 discs,ruptured type in 73 discs,and free type in 12 discs. Ninety-eight patients had lumbar and leg pain in one side,and 19 patients in double sides. MED was used to remove the nucleus and decompress the nerve root canal. Results: All the patients were followed up and the duration ranged from 48 to 84 months,with an average of 5.5 years. According to lumbar and leg pain evaluation criteria from spinal group of Chinese Orthopaedic Association,there were 93 patients got an excellent result,16 good and 8 poor. Conclusion: Appropriate control indications and skillful surgical techniques are the key points to decrease the complication and to improve the curative effect.