MED治疗腰椎间盘突出症91例临床分析

目的　探讨显微内窥镜腰椎间盘切除术 (Micro.Endoscopilc.Discectom y.MED)治疗腰椎间盘突出症的手术操作特点。手术适应症 ,并发症及临床效果 ,旨在正确认识这一新技术 ,提高手术疗效。方法　采用 MED治疗腰椎间盘突出症 91例 ,取后正中切口约 1.6 CM,操作间隙在 C臂 X光机准确定位后 ,按操作程序置入内窥镜 ,镜下行椎板间开窗切除椎间盘组织 ,对于伴有骨化及狭窄者 ,在特殊器械帮助下完成 ,对于进入椎管或止血十分困难者 ,选用自制的器械 ,行内窥镜下有限开窗术。结果　 91例均获得临床随访 ,时间 3个月— 1年 ,按陆裕朴疗效评定标准 ,优 80例 ,良 6例 ,可 3例 ,差 2例 ,优良率 94 .5 %。结论　 MED是一项发展中的技术。在发挥其优势的前提下 ,适应症的选择十分重要 ,预防手术并发症亦不可忽视。MED手术器械亟待改进 ,术者必须具备熟练的常规腰椎管手术技巧

Operative treatment of lumbar disc herniation with MED (clinical report of 91 cases)

Objective To explore and discuss the technical details, indication, complication and clinical results of MED for the treatment of lumbar disc herniation In order to hove a good understanding of the new technology and improving the operative results Methods Ninety-one cases of lumbar disc herniation were operated upon with MED Under the operative instruction, endoscopec was placed in through the 1 6 cm microendoscopic incision by the help of C-arm shape x-ray machine Under direct endoscopic manipulation, laminar fenestration and removal of the medial part of the facet were performed For patients with ossification and structure, the operation was finished by some particular instruments For patients with difficulties of entering into the spinal canal and controlling the bleeding It is necessary to have a limited laminar fenestration by self-made instruments Results All the 91 patients were followed up from 3 months to 12 months According to the Lu Yupu measurements Results:Excellent 80, good 6, fairly good 3 and bad 2, the rate of good-results is 94 5% Conclusion MED is a developing technology.When taking premise of its superiority, more attention must be paid to the indication and complication As a new technology, MED needs further improvement.So operators must be well versed in traditional lumbar disc and lumbar canal operations