应用显微内窥镜下椎间盘切除术治疗腰椎间盘突出症临床分析

目的总结腰椎间盘突出症经后路显微内窥镜（MED）手术治疗的疗效,探索其操作要点。方法 2004年5月至2009年12月对66例腰椎间盘突出症患者采用MED治疗,术中＂C＂臂X线定位相应节段,建立工作通道,在显微内窥镜下切除部分椎板、黄韧带和少量关节突内缘。牵开硬膜和神经根,显露突出的纤维环和髓核。切除髓核,减压神经根管。平均随访时间10.5个月,采用MacNab的腰椎评价标准评价。结果术后平均3d下地活动,平均住院时间9.4d。平均16d生活自理,5周恢复工作。优39例（59.1%）,良22例（33.3%）。优良率占92.4%。硬膜破裂3例,2例是定位穿刺针刺破,1例是切纤维环时切破,无神经根损伤。结论后路椎间盘镜手术创伤小,卧床时间短,恢复快,可以取得与开窗手术相近的效果。熟练精细的操作技术、充分的术前准备及正确的手术适应证选择是取得良好手术效果的重要环节。

Analysis of efficacy of microendoscopic discectomy for treatment of lumbar disc herniation

Objective To study the clinical results and technical details of microendoscopic discectomy（MED） for the treatment of lumbar disc herniation.Methods One hundred and thirty-two cases of lumbar disc herniation were operated on with MED from May 2004 to Dece.2009 For the operation,the location was decided and working channel was built under the＂C＂arm X-ray intensifier.A fenestration of lamina,removal of ligmentum flavum and slight medial part of the facet were performed endoscopically.After the nerve root and the dural sac were retracted medially,the annulus fibrosus was excised and the nucleus pulposus was removed.The Mac Nab＇s criteria was used to do the follow-up with the period of 10.5 months.Results After operation,averagely,the patients were able to walk in 3 days,stayed in the hospital for 9.4 days,managed their daily life in 16 days and resumed to work in 5 weeks.The rate of excellent and good results was 59.1% and 33.3% separately.3 cases had rapture of the dural sac with 2 cases punctuated by guide wire and 1 case cut by knife.No nerve deficit was happened.Conclusion MED is minimally invasive surgery.The result is as good as open fenestration surgery with shortened hospital stay and faster return to work;however,the techniques are more practical demand.