显微内窥镜下椎间盘切除术治疗复发性腰椎间盘突出症

目的:探讨显微内窥镜下椎间盘切除术(MED)治疗MED术后复发性腰椎间盘突出症的可行性和有效性。方法:2000年10月～2006年5月1572例腰椎间盘突出症患者进行MED治疗,术后9～61个月8例患者出现同节段典型的神经根损害症状和体征,MRI和CT证实为腰椎间盘突出。男5例,女3例,年龄25～47岁,平均35.6岁。均再次行单侧MED手术,其入路和经过与常规MED相似。结果:8例患者的神经根显露和减压良好,无转为开放手术病例。平均手术时间68min,平均失血量45ml,平均住院12.7d。1例术中发生脑脊液漏,无其它并发症。随访5～46个月,平均20.8个月,采用改良Macnab标准评价临床效果,优5例,良3例。结论:对于首次MED术后复发性腰椎间盘突出症患者,再次行MED仍是安全有效的治疗方法。     

MED椎间盘镜治疗腰椎间盘突出症

自2004年5月～2005年1月应用MED椎间盘镜手术系统对29例腰椎间盘突出症患者进行了腰椎间盘摘除手术，获得满意疗效，报告如下。     

后路显微内窥镜治疗腰椎间盘突出症

腰椎间盘突出症(Lumbosacral Disc Herniation,LDH)是导致下腰痛的常见病。随着光纤、显微摄像系统及手术器械的发展,后路显微内窥镜椎间盘切除术(Microendoscopic Discectomy,MED)得到发展应用,明显减轻了传统手术中难以避免的组织结构损伤。动物实验和临床观察证实,牵拉肌肉造成肌肉的损伤和失神经改变,可导致术后腰痛。我院自2002年5月,应用MED技术治疗LDH52例,总结如下：     

显微内镜与开放手术治疗腰椎管狭窄症的疗效比较

目的比较脊柱后路显微内镜手术(microendoscopy discectomy,MED)与传统开放手术治疗腰椎管狭窄症的疗效. 方法 2000年10月～2002年12月收治70例腰椎管狭症病人,分为两组,MED治疗30例(MED组),传统开放手术40例(开放组),两组进行比较. 结果 MED组优良率93.3%(28/30),对照组优良率90.0%(36/40),疗效无统计学差异(χ2=0.819,P=0.664);MED组手术时间明显短于开放组(t=2.295,P=0.025);MED术中出血量明显少于开放组(t=-42.344,P=0.000);MED组恢复正常工作/生活时间比开放组显著缩短(t=-30.123,P=0.000). 结论两组方法MED与开放手术治疗腰椎管狭窄症疗效相近,但MED手术时间短,术中出血量少,术后恢复快.     

不同术式治疗伴终板Modic改变的腰椎椎间盘突出症的疗效分析

目的 评估采用后路椎间盘镜下髓核摘除术(microendoscopic discectomy,MED)或后路椎间融合术(posterior lumbar interbody fusion,PLIF)治疗伴有终板Modic改变的腰椎椎间盘突出症患者的手术疗效.方法 回顾性分析2005年5月～2009年12月收治的73例伴...     

对腰椎后路椎间盘镜技术的一些看法(点评)

MED手术于1999年引进我国,并迅速推广.直至2003年初,已有200多家医院开展了MED,可见MED是微创脊柱外科中发展最快,应用最广的技术.MED具有微创、效果确实和容易掌握等特点,国内外文献报道其术后1年内优良率超过90%.然而有一些问题应当引起我们的重视.     

内窥镜下椎间盘切除术与显微椎间盘摘除术的比较研究

目的比较内窥镜下椎间盘切除术（MED）与显微镜下椎间盘切除术（MSLD）治疗腰椎间盘突出症的临床疗效。方法2004年10月-2007年6月,手术治疗腰椎间盘突出症91例,其中MED组46例,MSLD组45例。前瞻性比较2组术中出血量、手术时间、住院费用及功能评价等指标。结果MSLD组较MED组出血少、手术时间短、费用低,2组差异有统计学意义（P〈0．05）。MED组3例硬膜撕裂,MSLD组0例;MED组5例术中转开放手术,MSLD组0例。下床活动时间、住院时间及功能评定结果2组间差异无统计学意义（P〉0．05）。结论MSLD组较MED组手术创伤小、费用低、视野清晰、立体感强,是治疗腰椎间盘突出症更为安全的微创方法。     

显微内窥镜下椎间盘切除术及其与胶原酶溶核术联合治疗腰椎间盘突出症的疗效比较

目的:比较显微内窥镜下椎间盘除术(MED)及MED与胶原酶溶核术(CCNL)联合应用治疗腰椎间盘突出症的临床疗效。方法:120例腰椎间盘突出症患者中,60例单纯行MED治疗(MED组),另60例在行MED的基础上向椎间盘内注射胶原酶600U(MED CCNL组)。术后观察并分析两组的疗效及并发症。结果:两组均顺利完成手术,未发生并发症。术后全部病例随访6～48个月,按照MacNab标准评定,MED组有效率为83.3%,MED CCNL组为95%,后者明显高于前者(P<0.05)。结论:MED与CCNL联合治疗腰椎间盘突出症较单纯MED治疗具有更好的疗效。     

对腰椎后路椎间盘镜技术的一些看法

MED手术于1999年引进我国，并迅速推广。直至2003年初，已有200多家医院开展了MED，可见MED是微创脊柱外科中发展最快，应用最广的技术。MED具有微创、效果确实和容易掌握等特点，国内外文献报道其术后1年内优良率超过90％。然而有一些问题应当引起我们的重视。     

显微椎间盘镜下手术治疗腰椎间盘突出症及疗效分析

[目的]分析显微椎间盘镜手术(MED)治疗腰椎间盘突出症的疗效.[方法]回顾分析2000年11月～2004年12月间257例腰椎间盘突出症患者行MED手术的临床资料.[结果]本组257例获得随访,按照Macnab疗效评定标准:优191例,良43例,可17例,差6例;优良率91%.[结论]MED术具有创伤小,出血少,恢复快,疗效好等优点,但严格掌握手术适应证,熟练的镜下手术操作技巧,防止并发症发生是提高MED手术疗效的关键.     

Percutaneous diskectomy.

Automated percutaneous diskectomy and manual percutaneous diskectomy (PCD) have gained recent popularity as alternatives to traditional surgical diskectomy or microdiskectomy. Initial reports of morbidity seem low. The rates of infection, and neurologic and vascular complications appear comparable or less than the morbidity associated with surgical diskectomy or microdiskectomy. However, inconsistent reports of the efficacy of PCD may cause more concern about overuse than about the morbidity.     

Laparoscopic laser lumbar diskectomy

Approximately 300,000 patients each year in the United States undergo laminectomy for disabling lumbar disc herniation. Post-laminectomy hospitalization is 3–7 days and convalescence may be prolonged. As an alternative to laminectomy, we have developed a technique for performing L5-S1 lumbar diskectomy laparoscopically. Using an anterior approach, the intervertebral disc space is opened and the diskectomy is performed under direct videolaparoscopic imaging. After pneumoperitoneum is established, the patient is placed in a steep Trendelenburg position. The small bowel is retracted cephalad and the colon is moved to the left. The iliac vessels are identified visually and by Doppler probe, and the presacral space is dissected in the midline to expose the L5-S1 disc. In the case presented, the disc annulus was opened with the Nd:YAG contact laser, and diskectomy was performed under direct videolaparoscopic vision using standard neuro-surgical instruments modified for laparoscopy. The posterior longitudinal ligament can be visualized directly to define the posterior limits of the completed diskectomy. In the case described, pain relief was confirmed immediately after the procedure. The patient was discharged after 2 hospital days, and returned to normal activity in 8 days.     

改良直视下小切口微创手术与椎间盘镜及传统手术治疗腰椎间盘突出症的疗效比较

背景：近年来微创手术用于的腰椎间盘突出症手术治疗已得到了较广泛的发展,但目前采用的多数微创手术方法由于其设备昂贵、学习周期长,基层医院难以开展。本研究采用改良的直视下小切口微创髓核摘除术,为单纯腰椎间盘突出症的患者提供了新的治疗方法。 目的：比较改良的直视下小切口微创手术、椎间盘镜下及传统椎板切除手术治疗腰椎间盘突出的临床效果。 方法：回顾分析我院2002年1月至2010年7月收治的单节段腰椎间盘突出症患者143例,分为3组,分别接受改良的直视下小切口微创髓核摘除术（47例）、椎间盘镜下髓核摘除术（44例）及传统椎板切除髓核摘除术（52例）,并对各组的治疗情况和近期疗效进行比较研究。 结果：平均随访时间为：直视下小切口微创手术组425d,椎间盘镜手术组533d,传统手术组797d,采用日本骨科学会（JOA）关于下腰痛的评分标准进行疗效评定,3组患者治疗后优良率分别为：97．9％、95．5％、96．2％,治疗后平均改善率分别为：92．2％、87．6％、90．1％,组间比较无显著性差异（P〉0．05）,但在切口长度、术中出血量、术后卧床时间等方面,直视下小切口微创手术较传统手术显现了明显的优势,手术时间也较椎间盘镜组明显缩短,其差异有统计学意义（P〈0．05）。 结论：改良的直视下小切口髓核摘除术治疗腰椎间盘突出症的疗效肯定,创伤小,对脊柱正常结构的破坏轻微,患者恢复快,满意度高,而且学习曲线短、无需借助专用通道及光源等特殊手术器械,是一种值得推广的术式。     

经皮穿刺腰椎间盘切吸术后椎间隙感染

1994年 6月～ 2 0 0 0年 7月 ,我院采用经皮穿刺腰椎间盘髓核切吸术(ＰＬＤ)治疗腰椎间盘突出症 5 2 6例 ,发生椎间盘炎 5例 ,现进行回顾性分析。1　病例资料本组 5例 ,男 3例 ,女 2例 ,年龄2 9～ 5 2岁。病变间隙Ｌ4～Ｌ53例 ,Ｌ5～Ｓ12例。住院时间最短 70天 ,最长2 12天 ,平均 14 0天。主要临床特征 :术后 1周左右 ,术前症状缓解后再发生剧烈腰痛 ,轻微震动可诱发 ,病变椎间隙有深压痛、叩痛 ,并向双下肢和臀区、髋部放射。体温不超过 3 8℃ ,ＷＢＣ升高 ,血沉 5 0～ 12 0ｍｍ/ 1ｈ ,平均 70ｍｍ/ 1ｈ ,Ｃ反应蛋白 4 0～ 10 5ｍｇ/Ｌ ,平…     

Microlumbar diskectomy using loupesand headlights

The surgical treatment of herniated lumbar discs using microlumbar diskectomy techniques, loupe magnification,and headlights has a well documented, highly successful, outcome. The indications for surgery include: sciatica unresponsive to nonoperative treatment; profound or progressive motor deficit interfering with function; cauda equina syndrome. A radicular pain pattern, positive tension sign, and a corroborative imaging study which is consistent with the pain complaints are important in determining the patient who may benefit from the procedure. Visualization and hemostasis are important. Positioning with the abdomen free decreases epidural venous engorgement and intraoperative bleeding. The nerve root should be clearly identified before retraction. This includes the use of magnification (eg loupes (3.5 power) and a headlight, or microscopic), adequate soft tissue and bone removal to allow identification of the root edge, and familiarity with techniques to decrease bleeding (bi-polar electrocoagulation and hemostatic agents). At the completion of the procedure, all free fragments of disk should be removed and any current stenosis addressed. The root should be free in tension and compression. It should be possible to freely pass a dural elevator anterior and posterior to the root, out the foramen. With the appropriate indications, timing and surgical technique one can anticipate a 90% to 95% clinical success rate in relieving radicular leg pain related to a herniated lumbar disk.     

Targeted percutaneous transforaminal endoscopic diskectomy in 295 patients: comparison with results of microscopic diskectomy

BACKGROUND: The aim of this study is to compare the clinical outcomes and complications after targeted PTED and conventional microscopic diskectomy for removing 1-level unilateral LDH and to evaluate the efficacy of PTED for the treatment of LDH. METHODS: The authors retrospectively examined 915 consecutive patients who underwent PTED (group A, 301 patients) and microscopic diskectomy (group B, 614 patients) for 1-level unilateral LDH. Patients who were treated with a diskectomy in the period from July 2003 to December 2004 were evaluated by telephone interview and institute visit. This assessment was performed at least 18 months (range, 18-36 months) after their operation. The follow-up rate in groups A and B was 97.5% (295 patients) and 96.5% (607 patients), respectively. RESULTS: Good or excellent results were obtained in 84.7% and 85.0% of groups A and B (P = .92). The rates of recurrence were 6.44% and 6.75% in groups A and B (P > .05). Twenty-eight patients (14 cases of recurrence, 5 cases of incomplete removal, 5 cases of stenosis, 2 cases of diskogenic back pain, and 2 cases of diskitis) in group A and 38 patients (26 cases of recurrence, 6 cases of incomplete removal, 2 cases of stenosis, 2 cases of diskogenic back pain, 1 case of hematoma, and 1 case of diskitis) in group B underwent reoperation. CONCLUSIONS: Based on our results, the PTED can be a reasonable alternative to a conventional microscopic diskectomy for the treatment of patients with LDH, except for those in downward far-migrating cases beneath the pedicle of the lower vertebra or in cases involving L5-S1 with a high pelvis.