内窥镜下保留黄韧带的腰椎间盘摘除术(附65例临床报道)

目的：探讨内窥镜下腰椎间盘摘除术中保留腰椎黄韧带的可行性和临床效果。方法：对65例腰椎间盘突出症患者(L4／5 39例，L5／S1 26例)在常规内窥镜操作下显露腰椎板间隙，用微型手术刀切开并剥离黄韧带。将黄韧带向中线卷曲剥离成上、外、下三面游离的黄韧带瓣，椎间盘切除后再将黄韧带进行复位。结果：65例患者手术切口均一期愈合，无神经根损伤、椎间隙感染和脑脊液漏等并发症。随访6～24个月，平均14．5个月，疗效评定按Nakai标准，优42例，良18例，可3例，差2例。2例差者行开放手术翻修术。翻修术中见保留的黄韧带与椎管外疤痕粘连明显，但与椎管内的粘连较轻。结论：内窥镜下保留腰椎黄韧带不但技术操作可行。而且能降低术后腰椎管外瘢痕向腰椎管内长入，是非常好的天然屏障。

Microendoscopic lumbar discectomy with the preservation of the ligamentum flavum (report of 65 cases)

Objective:To explore the surgical technique,indication and the clinical effects of microendoscopic lumbar discectomy with the preservation of the ligamentum flavum.Method:65 patients suffered from lumbar disc herniation(39 cases at the L4/5 and 26 cases at L5/S1).After exposure the interlaminar space under the microendoscopic,the ligamentum flavum which like a valvelar structure with superior,inferior and lateral edge was retracted medially using nerve-retractor.and released the ligamentum flavum after discectomy.Result:All patients were followed up from 6 to 24 months(average 14.5 months).Acording to Nakai standard,42 cases were excellent,18 good,3 improved and 2 worse.It was found during the revision-operation that it was tightly adhered to the outside of ligamentum flavum,but very light adhesion was found inside the yellow-ligament.Conclusion:The ligamentum flavum preservation technique is feasible under microendoscope and it is helpful in reducing the epidural fibrosis and scar formation.So it was a very good natural barrier of the spinal canal.