后路椎间盘镜治疗腰椎管狭窄症临床体会

目的 探讨后路椎间盘镜治疗椎管狭窄症的临床应用、手术适应证和临床效果.方法 采用后路椎间盘镜进行单侧或双侧"开窗"彻底解除硬脊膜及神经根的压迫.术中通过"C"臂机或拍摄侧位X线片定位.在局麻或浅硬外麻醉下于腰后部正中做大约1.5 cm的切口,逐级扩张后置人工作通道管,钻除部分椎板,置入内窥镜于电视监视下显露清除椎板、增生内聚的关节突、肥厚的黄韧带及突出的椎间盘髓核组织,减压神经根管,彻底解除其对硬膜、神经根的压迫.结果 本组共治疗183例,随访5个月至3年,按Nakai标准评定,优168例,良9例,可6例,优良率为96.7%.结论 本方式创伤小、出血少、恢复快,在保证神经根充分减压的前提下,能尽可能保持脊柱的稳定性.本方法适用于单节段或多节段椎管狭窄症及合并椎间盘突出的患者.

Microendoscopy in posterior lumbar intervertebral stenosis

Objective To evaluate the clinical outcome of lumbar spinal canal stenosis treated by microen-descopic discectomy. Methods The rear guard intervertebral discoscope was used to carry on unilateral or-bilateral "windowing" to relieve the dura mater spinalis and the nerve root oppression thoroughly. The "C" ann machine or laferal side photography position X was used for localization. Approximately 1.5 cm incision was made under local anesthesia or under the shallow epidural anaesthesia at posterior waist, the pathway tube was implanted after progressive expansion, part of lamina of vertebra was removed by drill, endoscope was inserted under the television surveillance to reveal removed lamina of verfebra, the proliferated cohesed articular process, the plump yellow ligament flava and the bulging intervertebral disc nucleus pulposus tis-sues, the nerve root canal was depressed, to relieve thoroughly its oppression, dura mater and nerve root. Results The follow-up continued from 5 months to 36 months. The evaluation with Nakai scale revealed ex-cellent in 168 cases, good in 9 cases, fair in 6 cases. The rate of good results was 96.7%. Conclusions Totally 183 cases were treated with this procedure posterior microendoscropie discectomy shows minimal inva-sion, less blood loss and quick recovery. The stability of lumbar spine can be reserved. It is safe and effec-tive for treating lumbar disc herniation complicated with spinal stenesis.