显微内窥镜椎间盘突出症镜下手术标准的探讨

目的：探讨显微内窥镜治疗腰椎间盘突出症（lumbosacral Disc Herniation LDH)的镜下手术标准，方法：回顾总结208例（248个椎间隙）LDH经显微内窥镜椎间盘摘除术（Microendoscopic Disectomy,MED)的临床资料。结果：该组病例均获得随访，随访时间平均8个月，按Macnnab标准评定，优176例，良18例，可14例，优良率93．27％。结论：MED手术是一种微创化的现代技术，为确保手术的精确性和安全性，该文提出了4项MED镜下手术标准，定位：镜下视野包括上位椎板的下缘和下关节突的内侧缘（L3／L4，L4／L5约占据视野的1／2，L5／S1约占据视野的1／5）。椎管显露，选用以椎板下缘与下关节突内侧缘的三角区，突破黄韧带为安全的手术入路，髓核摘除；应彻底切除凸入椎管内的突出物并根据不同年龄行间隙内髓核摘除，神经根管扩大；神经根行程无卡压，神经根内外移动度达0．5cm，出口能容纳直角神经根探子。

The Exploration of Surgical Criteria of LDH with MED

Objective:To explore the surgical criteria of Lumbar Disc Herniation(LDH) with Microendoscopic Discectomy (MED).Methods:By reviewing and analysizing the clinical materials of 208 patients(265 intervertebral discs)of LDH with MED.Results:All cases were followed up averagely 8 months.142 cases were evaluated as excellent,52 as good,14 as fair according to the Macnnab scale.Conclusions:The MED is a minimally invasive modern technique.To ensure the accuracy and safety of operation,the paper provides the following surgical criteria.First,location the endoscopic view should include the inferior margin of the upper lamina and the medial edge of the superior facet.Second,expousure of spinal canal.Selecting the triangular working zone between the inferior margin of the upper lamina and the medial edge of the superior facet and cuting though the ligamentum flarum as a safety path to operate.Third,removing the herniatied nucleus pulposus,making a through removing of the herniation in spinal canal and eliminating the nucleus in disc space according to the different ages.Fouth,enlargeing the nerve root canal.No compression in nerve root,the range of movement of nerve root is about 5 mm,the orifice can contain the right-angle explorer.