应用椎间盘镜手术治疗合并侧隐窝狭窄的腰椎间盘突出症

目的观察经后路椎间盘镜（MED）手术治疗合并有侧隐窝狭窄的腰椎间盘突出症的手术技巧及临床疗效。方法对73例腰椎间盘突出症伴侧隐窝狭窄患者，在持硬膜外麻醉下，床旁C臂机定住，MED下行推板间隙开窗，摘除突出椎间盘髓核组织，通过调整手术通道以及采用特殊器械对增生内聚的关节突进行有限切除，对侧隐窝、神经根管潜行扩大，对神经根进行彻底减压，并对病人术后疗效进行分析。结果73例患者，平均住院9．7天，平均手术出血量58毫升，平均手术时间73分钟。术后65例得到随访，按Nakai标准，优55例，良7例，可3例，优良率95．4％。结论该术式较常规手术创伤小，出血少，保持了脊柱后柱完整性与稳定性，适用于单节段腰椎间盘突出症合并相同节段侧隐窝狭窄症。

Treatment of lumbar disc herniation with stenosis of lateral recessus by microendoscopy discectomy

Objective To investigate the skills and clinical effects of microendoscopic discectomy in the treatment of lumbar disc herniation with stenosis of lateral recessus. Methods After the epidural anesthesia,the surgical approach was under the guidance of C-arm computer. The herniatca disc were removed and the lateral recessus were enlarged by resecting the hyperplastic articular process with particular devices. The nerve roots were thoroughly decompressed. The effects of the operation were analyzed. Results 73 patients were treated with MED. The average hospital stay was 9.7 days, average hemorrhage volume 58mland average operation time 73 minutes. Of 65 cases followed up, 55 was the excellent effects. The rate of fineness was 95.4%. Conclusion the operation has smaller incision, less hemorrhage compared with conventional operation, which keeps integrity and stability of the posterior structure of spinal column and is also suitable for Lumbar Disc Herniation Combined with Stenosis of Lateral Recessus.