自动神经牵开器在显微内镜椎间盘切除术中的应用

 目的 探讨自动神经牵开器在显微内镜椎间盘切除术(micro-endoscopic discectomy，MED)中的作用与临床效果。方法 回顾性分析2009年8月至2010年12月，应用MED治疗腰椎间盘突出症350例患者资料，男196例，女154例；年龄17～68岁，平均42岁；L_1-2 3例，L_2-3 8例，L_3-4 12例，L_4-5 186例，L₅S₁ 141例。突出类型：中央型31例，旁侧型266例，极外型23例，破裂游离型30例。其中合并钙化37例，合并椎管狭窄66例。患者在MED中均应用自动神经牵开器。采用视觉模拟评分(visual analogue scale，VAS)和Oswestry功能障碍指数(Oswestry disability index，ODI)评估患者术后疗效。结果 350例患者均获得随访，随访时间6～16个月，平均9个月。VAS评分，术前(8.79±1.15)分，术后3个月(3.80±1.14)分，术后6个月(3.65±1.14)分。ODI，术前78%±1.71%，术后3个月28%±1.72%，术后6个月28%±1.88%。术后各个时间点VAS评分和ODI均较术前有明显改善，术后各时间点比较无明显差异。术后无一例发生脊髓及神经根损伤、硬膜外血肿形成。1例发生椎间隙感染，给予切吸、引流，卧床休息，消炎止痛等对症治疗3周后治愈。2例术后切口发生缝线反应导致切口延迟愈合，经拆线后清洁换药3～4周痊愈。1例术后切口发生感染，经清洁换药及对症治疗6周后痊愈。2例患者因长时间卧床缺少活动而致下肢静脉血栓形成，其中1例经物理疗法、药物及对症治疗后康复，另1例经介入放置滤网结合药物溶栓得以康复。结论 在MED中配合使用自动神经牵开器可有效显露术区，保护周围神经不受损伤，减轻手术人员的工作量，有较好的临床应用价值。

The application of automatic nerve retractor in micro-endoscopic discectomy

Objective To explore the function and clinical effect of automatic nerve retractor in micro-endoscopic discectomy. Methods From August 2009 to December 2010, 350 patients with lumbar disc herniation were treated by micro-endoscopic discectomy, including 196 males and 154 females, aged from 17 to 68 years (average, 42 years). Three cases were at L_1-2, 8 at L_2-3, 12 at L_3-4, 186 at L_4-5 and 141 at L5S1. The automatic nerve retractor was used in all micro-endoscopic discectomy. The visual analogue scale (VAS) and Oswestry disability index (ODI) were used to evaluate clinical outcomes. Results All patients were followed up for 6 to 16 months (average, 9 months). The mean VAS score decreased from preoperative 8.79±1.15 to 3.80±1.14 3 months after operation and 3.65±1.14 6 months after operation. The mean ODI score decreased from preoperative 78%±1.71% to 28%±1.72% 3 months after operation and 28%±1.88% 6 months after operation. Postoperative VAS and ODI scores decreased significantly compared with those before operation. The VAS and ODI scores 6 months after operation were not significantly improved compared with those 3 months after operation. No spinal cord and nerve root injury and epidural hematoma formation occurred in all cases. Conclusion In micro-endoscopic discectomy, the automatic nerve retractor can help the operator obtain effective exposure, protect nerves from injury, alleviate workload of the operators, therefore it has a great clinical application value.