显微内窥镜下手术治疗腰椎管狭窄症的初步探讨

目的：探讨显微内窥镜下手术治疗腰椎管狭窄症的方法，并对临床应用的有效性和可行性进行初步评价。方法：使用METRx系统对18例腰椎管狭窄症患者按标准显微内窥镜下椎间盘髓核摘除术(MED)方法操作，经椎板间隙切除黄韧带、部分椎板和关节突，充分减压硬膜囊和神经根。分析患者临床资料，并对临床疗效进行评定。结果：平均手术时间94min，平均术中出血75ml，平均住院日12．6d。发生硬膜撕裂1例。术后平均随访8．2个月，采用Nakai标准评定临床疗效，优12例，良4例，可2例。平均恢复正常工作和日常活动时间38d。结论：显微内窥镜下手术能够充分解除硬膜囊及神经根压迫，并能维持腰椎稳定，术后效果优良。

Preliminary study on microendoscopic surgery for lumbar stenosis

Objective:To study the method of microendoscopic surgery for lumbar stenosis and to present preliminary evaluation on the feasibility and efficacy of using the technique.Method:A total of 18 consecutive patients(12 males and 6 females) with lumbar stenosis underwent microendoscopic surgery,whose mean age was 47.8 year(42~65 year).The procedure was performed under standard microendoscopic discectomy(MED) technique and METRx system.Resection of ligamentum flavumtan,part vertebral lamina and facet joint was conduted.Followed by thorough nerve root and dural sac decompression.The surgical technique was summarized and the retrospective study on preliminary clinical results was presented.Result:The mean operative duration was 94 minutes.The average bleeding volume during operation was 75ml,and mean hospital stay was 12.6 days.Dural tear occurred in one patient.Mean follow-up time was 8.2 months after surgery.Clinical outcomes were determined using a Nakai criteria,which revealed that 12 patients had excellent,4 good,2 fair outcomes.The average period of returning to work or normal activity was 38 days.Conclusion:The microendoscopic surgery has characteristics of minimal incision,little tissue intervention.A thorough nerve root and dural sac decompression can be performed via minimal invasive approach.Meanwhile,the spinal stability as well as good clinical outcome may be obtained.