退变性巨大型腰椎间盘突出症的椎间盘镜治疗策略

目的通过回顾性研究，探讨腰椎间盘镜下治疗退变性巨大型腰椎间盘突出症的策略和疗效。方法2005年6月至2007年9月，经椎间盘镜下治疗37例退变性巨大型腰椎间盘突出症患者，男29例，女8例；年龄33～65岁，平均43．6岁；L3-4 2例，L4-5 21例，L5S1 14例。患者均有不同程度的腰骶部不适或疼痛，其中17例伴双侧下肢症状，15例伴单侧下肢症状，5例伴大小便功能障碍。术后采用Maenab疗效标准评估手术效果。结果术后随访3～12个月。优良30例，可2例，优良率81．1％。手术切口均一期愈合，无神经根损伤、椎间隙感染及脑脊液漏等并发症。结论运用椎间盘镜工作通道，采用椎板间隙入路通过单侧或双侧椎板开窗术，治疗退变性巨大型腰椎间盘症，既可切除突出椎间盘组织，解除硬膜囊和神经根压迫，又可最大限度保护脊柱的稳定性，取得满意的临床疗效。

Treatment strategy of the great degenerative type lumbar disc herniation by microendoscopic discectomy

Objective To summarize and discuss the methods and the effect on the great degenerative type of the intervertebral disc herniation treated by microendoscopic discectomy. Methods： Totally 37 patients （29 males, 8 females） enrolled in our hospital from 2005 to 2007 were analyzed retrospectively, who were diagnosed by great degenerative type lumbar disc herniation and treated by microendoscopic discectomy, L3-4 in 2, L4-5 in 21, L5S1 in 14, course of disease 5 - day to 7 - year. The functional evaluation was performed by Macnab scoring system post - operatively. Results ： Fol- low -up duration was 3 - 12 months; the patients had good or excellent results above 81.1%. Conclusion： It is satisfied that the cases with great degenerative type lumbar disc herniation can be treated by microendoscopic discectomy through the interlaminar