显微内镜髓核摘除术治疗腰椎间盘突出症

目的探讨显微内镜髓核摘除术(microendoscopic discectomy,MED)治疗腰椎间盘突出症或伴有腰椎管狭窄的疗效.方法216例采用髓核钳清除椎板上方的软组织,刮匙刺破黄韧带,枪式咬骨钳咬除黄韧带及部分椎板下缘,牵开神经根,暴露突出髓核并摘除,伴侧隐窝狭窄者扩大成形.结果2例术中出血多改为开放手术.216例随访3个月～4年,平均2.5年.按Nakai疗效评定标准:优210例,良2例,可1例,差3例,优良率98.1%(212/216).2例术后3个月疗效差,二次开放手术;1例因腰椎间盘突出症伴椎体间轻度结核,漏诊结核致手术效果差.结论MED治疗腰椎间盘突出症创伤小,对脊柱结构稳定性的破坏小,术后病人恢复快,临床疗效满意.

Curative effects of microendoscopic discectomy for lumbar disc herniation

Objective To analyze clinical effects of microendoscopic discectomy in the treatment of lumbar disc herniation with or without lumbar spinal stenosis.Methods A total of 216 patients were included in the study.The patient was maintained in the prone position on an arch-like bed.Under C-arm fluoroscopic guidance,a thin pin was inserted down to the facet of the target level.A longitudinal incision was made approximately 1.7 cm at the level of the disease to introduce a series of dilators,over which a working channel was then established.Once extraneous soft tissues were removed,a curette was used to puncture the ligamentum flavum.And the local ligamentum flavum and part of inferior border of the adjacent lamina were removed with a gun-shaped rongeur.The disc space was incised and a discectomy was performed.The lateral recess was cleared of any bone stenosis.Results conversions to open traditional discectomy were conducted in 2 patients because of bleeding.The 216 patients were followed for 3 months ~ 4 years with an average of 2.5 years.According to the Nakai criteria,excellent outcomes were achieved in 210 patients,good in 2 patients,fair in 1,and poor in 3,the rate of excellent or good outcomes being 98.1%(212/216).Of the 3 patients with poor outcomes,2 patients were given a re-operation of traditional surgery 3 months after the microendoscopic discectomy and 1 patient had a missed diagnosis of spinal tuberculosis.Conclusions Microendoscopic discectomy in the treatment of lumbar disc herniation gives little influence to spinal stability and satisfactory clinical effects.