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不采用术中X线定位的后路椎间盘镜髓核摘除术治疗腰椎间盘突出症
引用本文:戎利民,蔡道章,董健文,史德海. 不采用术中X线定位的后路椎间盘镜髓核摘除术治疗腰椎间盘突出症[J]. 中国内镜杂志, 2008, 14(2): 138-139,142
作者姓名:戎利民  蔡道章  董健文  史德海
作者单位:中山大学附属第三医院,骨科,广东,广州,510630
摘    要:目的探讨后路椎间盘镜手术中不采用X线定位的可行性。方法269例腰椎间盘突出症患者行后路椎间盘镜髓核摘除术,不采用X线进行术中定位。根据术前腰椎平片,通过骨性标志的触摸和术中细针穿刺确定手术间隙并建立工作通道,术中可根据手术情况适当调整工作通道位置。结果手术时间30~90min,269例患者中,267例首次置入工作通道定位准确,2例术中发现定位错误(神经根松弛无间盘突出),移动工作通道完成手术,无需重新切口。术后所有患者腰腿痛症状消失或缓解,复查X线照片未发现手术节段错误。并发马尾神经损伤1例,单纯脑脊液漏4例,切口愈合不良2例。结论参照腰椎平片,通过骨性标志的仔细触摸和术中细针穿刺定位,不采用术中X线定位的后路腰椎间盘镜手术确实可行,并节省术中定位时间,避免患者和医护人员的射线接触。

关 键 词:腰椎间盘突出症  后路椎间盘镜  微创外科  用术  定位时间  后路椎间盘镜  髓核摘除  术治疗  腰椎间盘突出症  射线接触  医护人员  确实可行  腰椎间盘镜手术  穿刺定位  细针  切口愈合不良  脑脊液漏  马尾神经损伤  发现定位  照片  痛症  术后  移动
文章编号:1007-1989(2008)02-0138-02
收稿时间:2007-07-28
修稿时间:2007-07-28

Microendoscopic discetomy for lumbar intervertebral disc protrusion with no intro-operative fluoroscopy guiding
RONG Li-min,CAI Dao-zhang,DONG Jian-wen,SHI De-hai. Microendoscopic discetomy for lumbar intervertebral disc protrusion with no intro-operative fluoroscopy guiding[J]. China Journal of Endoscopy, 2008, 14(2): 138-139,142
Authors:RONG Li-min  CAI Dao-zhang  DONG Jian-wen  SHI De-hai
Abstract:[Objective] To dissuss the feasibility of performing microendoscopic discectomy without Intro-operative fluoroscopy guiding. [Methods] 269 patients were managed by means of microendoscopic discectomy. The level of appropriate disc space was located by means of anatomical landmark palpation and needle puncture. With no Intro-operative fluoroscopy monitoring, the tubular retractor was located at appropriate place and could be adjusted with respect to lamina. [Results] The operating time was 30~90 minutes. There were no final mistakes of disc space localization verified by post-operative radiograph. Localization of the disc space level were perfect in 267 cases. The 2 mis-located situation were found during procedure and successfully adjusted by the tubular retractor. There were no severe complications. Only 1 case of mild cauda equina injury, 4 cases of cerebrospinal fluid leakage and 2 cases of poor incision healing were found. [Conclusions] Microendoscopic discectomy can be performed successfully with no intro-operative fluoroscopy guiding, which saves operating time and avoids roentgen exposure of medical staff and patients.
Keywords:lumbar intervertebral disc protrusion  microendoscopic discetomy  invasive surgery
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