显微内镜手术治疗极外侧型腰椎间盘突出症

目的介绍显微内镜手术治疗极外侧型腰椎间盘突出症的方法,分析其临床效果。方法16例极外侧型腰椎间盘突出症(椎间孔内型7例,椎间孔外型9例)接受显微内镜手术。5例椎间孔内型采用常规显微内镜椎间盘髓核摘除术入路,切除部分椎板、椎弓峡部和小关节。2例椎间孔内型采用经关节突入路,使用X-tube工作通道,切除大部分关节突。9例椎间孔外型采用横突间入路,工作导管置于横突间,部分切断横突间韧带。所有手术均需找到受压神经根并松解,切除突出椎间盘。结果术后平均随访8·3个月,采用改良MacNab标准评定临床结果,优12例,良3例,可1例。平均住院日13·8d,平均手术时间78min,平均术中出血68ml。结论显微内镜手术治疗极外侧腰椎间盘突出症具有小切口和组织损伤轻的优点,能够充分直接探查松解神经根压迫。

Microendoscopic Surgery for Far Lateral Lumbar Disc Herniation

Objective To introduce the method and analyze the clinical efficacy of microendoscopic surgery for the treatment of far lateral lumbar disc herniation.Methods A total of 16 consecutive patients with far lateral lumbar disc herniation (7 with interforaminal disc herniation and 9 with extraforaminal disc herniation) underwent microendoscopic surgery.Five patients with interforaminal disc herniation were operated according to common microendoscopic discectomy and removal of part of vertebral lamina,isthmus of vertebral arch and zygapophysis were performed.Two patients with interforaminal disc herniation received following procedure.The working canal (X-tube) was used and large part of zygapophysis was removed.Nine patients with extraforaminal disc herniation were operated through intertransverse processes approach.The working canal was put into intertransverse processes.Intertransverse processes ligament was partly dissected.The compressed nerve root was found and loosened and the herniated disc was removed. Results Mean follow-up time was 8.3 months after surgery.Clinical outcomes were determined using the modified MacNab criterion,which revealed that 12 patients had excellent result,3 patients good,1 patient fair result.Average hospital stay was 13.8 days.Mean operative time was 78 minutes and mean bleeding volume was 68 ml.Conclusion The microendoscopic surgery for far lateral lumbar disc herniation allows a smaller incision,less tissue trauma,thorough root exploration,direct evaluation of the compression.