应用腰椎后路椎间盘镜手术治疗腰椎间盘突出症

目的探讨应用腰椎后路椎间盘镜手术治疗腰椎间盘突出症的手术适应证、术中操作要点及并发症处理。方法2002年10月至2005年12月经临床明确诊断为腰椎间盘突出症36例,男16例,女20例;年龄18~69岁,平均年龄46.7岁,其中第3~4腰椎1例,第4~5腰椎19例,第5腰椎~第1骶椎15例,第4~5腰椎合并第5腰椎~第1骶椎1例。分别采用腰椎后路椎间盘镜手术进行单节段或多节段、单侧或双侧"开窗"减压、"长槽式"减压及潜行神经根减压。手术切除椎间盘单节段35例,双节段1例。结果36例随访3个月~2年,平均1.5年。疗效为优29例(80.6%),良6例(16.7%),差1例(2.8%),优良率97.2%。术中出血60~250 ml,平均120 ml。手术时间40 min~3.2 h。硬脊膜破裂2例,1例二次后路椎间盘镜手术,无一例发生椎间隙感染或发生神经器质性损伤。术后第1天即可下床活动,1周后基本恢复自由活动。结论腰椎后路椎间盘镜手术减压充分适应证宽、创伤小、出血少、术后恢复快,初学者应严格掌握适应证,熟练操作技术,尽可能提高疗效,减少手术并发症。

Application of intervertebral disc endoscope through posterior approach for prolased lumbar intervertebral disc

Objective To analyse the indications,intraoperative problems and management of complications of intervertebral discs endoscope through posterior for lumbar intervertebral disc protrusion.Methods Thirty-six patients were diagnosed as lumbar intervertebral disc protrusion.There were 16 males and 12 females,their age was from 18-69,with an average age of 46.7 years.Among them,L3-4 in 1,L4-5 in 19,L5S1 in 15,L4-5 combined L5S1 in 1.They were treated with translaminar fenestration,translaminar notching and undermining enlargement of the neural canal in single or multiple segments by intervertebral disc endoscope through posterior unilateral or bilateral approach.Thirty-five herniated discs of the single level were removed,1 of the double level.Results All the 36 patients were followed up from 3 months to 2 years,with an average of 1.5 years.The clinical results were rated as excellent in 29 cases(80.6%),good in 6(16.7%)and poor in 1 case(2.8%),the rate of excellent and good outcomes was 97.2%.The blood loss varied from 60 to 250 ml with an average of 120 ml.The operative time ranged from 40 minutes to 3.2 hours.Two case in spinal dura mater break.One case was treated with intervertebral discs endoscope successfully.No one suffered from intervertebral infection and no nerve injury occurred during operation.Patients could get off bed in the first postoperative day,and they could move freely in about one week.Conclusion The procedure has more indications and some advantages of minimal invasion,less bleeding,high security,quick recovery on the premise of providing completely decompression to spinal cord and nerve root.The new learner should control appropriate indications and technique to improve the curative effect and to decrease the complication.