椎间盘镜手术治疗腰椎间盘突出症

目的：评价椎间盘镜手术治疗腰椎间盘突出症的临床疗效。方法：腰椎间盘突出症患者15例，男11例，女4例；平均年龄39．8岁。在椎间盘镜下行腰椎间盘髓核切除、椎板减压及神经根管扩大术。术前在X线机下，分别于病变节段上位棘突下缘、上位椎板下缘中点定位，置人内窥镜头。在椎间盘镜配套的监视器下咬除部分椎板下缘及黄韧带，扩大椎板间隙，清除椎间盘髓核组织，扩大神经根管。结果：本组除1例患者因术中硬膜囊破裂改为开放手术，其余14例平均手术出血量60ml，平均手术时问86min。本组平均随访时间13．2个月，按照Nakai评级，优11例，良3例，可1例。结论：椎间盘镜手术治疗腰椎间盘突出症比常规手术方法视野清晰、创伤小、恢复快，基本保持了脊柱后柱完整。

Microendoscopic discectomy in treatment of lumbar intervertebral disc herniation

Objective:To evaluate the clinical outcomes of microendoscopic discectomy for treating lumbar intervertebral disc herniation.Methods:Fifteen patients(11 male,4 female;the mean age of 39.8 years)with the lumbar intervertebral disc herniation were treated by the discectomy,vertebral laminar decompression and the nerve root canal enlargement under the microendoscopy.Under X-ray,midpoint of the inferior border of spinous process and vertebral lamina on superior of the lesion segment were localized,and the microendoscopy was placed.The inferior border of vertebral laminar and ligamentum flavum were removed.The interspace of vertebral laminar were enlarged.Nucleus pulposus of intervertebral disc were cleared.The nerve root canal were enlarged.Results:Among 15 cases,1 case was treated by traditional discectomy because of dura mater ruptured;The other 14 cases were treated successfully by microendoscopic technique.The average amount of operative hemorrhage was 60 ml and the average operative time was 86 minutes.After an average follow-up of 13.2 months,according to Nakai scale,the result were excellent in 11 cases,good in 3 cases,fair in 1 case.Conclusion:Microendoscopic discectomy has virtue by clearer operative field,few trauma,and quick recovery than traditional discectomy and is keeping the posterior structure of the lumbar vertebrae.