显微内镜治疗腰椎间盘突出症的手术适应证及其疗效分析

目的：报告显微内镜椎间盘手术系统（MED）治疗腰椎间盘突出症的治疗体会。探讨此技术的基本概念，手术适应证，禁忌证、手术操作要点和临床早期效果。方法：对35例单或多平面腰椎间盘突出症患均在浅硬膜外麻醉下通过脊柱MED行突出间盘除术，观察患术后的疗效并进行分析比较，结果：术后患的症状都有明显的缓解，虽然治疗效果与常规开放手术相同，但患术后第3天即可下床活动，切口仅长1．6cm，行皮内缝合，不需拆线，本组患均在术后3－5d出院，无手术并发症，平均随访10个月，随访期间无1例患出现复发，腰椎不稳。结论：MED治疗腰椎间盘突出症的效果与常规开放手术相同，但该手术具有创伤小，出血少，患术后恢复快，不影响腰椎稳定等优点，是治疗腰椎间突出症的有效方法之一。

Indication and therapeutic effects of microendoscopic discectomy system in treatment of lumbar disc herniation

Objective:To summarize the experience on lumbar disc herniation treatment with microendoscopic discectomy (MED) system, and to study the basic concept, surgical technique, indication, contraindication and clinical curative effects of MED. Methods:Thirty five patients with single or 2 level lumbar disc heniation were treated with MED under epidural anesthesia. The clinical outcome and the image changes of some pre and post operative MRI were evaluated. Results: The average duration of follow up was 10 months and the successful clinical results was 97.1%. All patients apparently felt remission after operation. The therapeutic effects of MED was the same as routine open operation, but the patients were allowed to walk 3 d and were discharged 3 5 d after operation, and there was no complication occurred. The length of incision was only 1.6 cm. The image changes of pre and post operative MRI showed that the heniated disc disappeared and the compression was relieved completely. Conclusion:MED in treatment of lumbar disc herniation is a minimum invasive procedure. MED has low blood loss and little harm on spine stability, patients can recover from the surgery within 1 week.