摘要
目的探讨后路椎间盘镜在侧俯卧位时单切口内行相邻双节段腰椎间盘摘除术的可行性和疗效。方法自2005年以来,在原来俯卧位的基础上改进手术体位,置患者于侧俯卧位,患侧在下,采用椎旁1.8cm长纵形切口。常规行双节段腰椎间盘摘除神经根松解术。结果32例患者术中均未出现严重心血管并发症,无椎管内静脉丛损伤,出血<70ml,无硬膜囊及马尾神经损伤,手术时间45～90min左右。出血量减少,手术时间缩短。28例患者获得随访,时间为8～15个月,按Macnab疗效标准:优良率92.9%。结论针对合并有心血管疾病及肥胖和明显消瘦的患者,由于双节段手术时间相对较长,患者耐受性差,改进体位后,手术中出血减少,手术时间缩短,术中并发症少,便于麻醉观察,手术得以顺利进行。侧俯卧位下,一个切口内通过移动工作通道可以完成相邻双节段腰椎间盘手术。患者创伤小,痛苦少,恢复快,临床效果满意。
Objective To explore the feasibility and clinical effect of the new lateral-prone position while completing two adjacent lumbar diseectomy via single incision using posterior approach MED surgical system. Methods 32 patients （ 17 male and 15 femal） with two adjacent disc herniation were treated with posterior approach MED surgical system since 2005. All the pa- tients lay lateral-prone on the bed with the suffering side lower and were performed with nomal MED （microendoscopic disecto- my）. Results No severe cardio-vascular complications occure. Neither do any injury of the intravertebral vein plexus or dural in2 jury or cauda equina injury. The blood loss（not more than 70rrd each）and the average operative time （range from 45 to 90 mi- nutes） are smaller. The 28 cases were followed up from 8 to 15 months. The clinical result was rated as excellent or good in 26 ca- ses （92. 9% ） according to the Macnab score. Conclusion As for the case who is going to be perfomed two adjacent lumbar dis- cectomy using MED surgical system, the new lateral-prone positon with single incision procedure has an advantage over the former prone positon with two incisions in blood loss, average operative time and complication rate, especially for the one who suffers from cardio-vascular disease,overweight or low weight. With patient lying lateral-prone, doctors can complete two adjacent lumbar dis- cectomy by shifting the working passage within single incision. With the new procedure,the patient can get minimal invasion, qick recovery and satisfactory clinical result.
出处
《四川医学》
CAS
2009年第8期1186-1188,共3页
Sichuan Medical Journal
基金
四川省科技厅攻关基金课题(05SGD22-088)
关键词
后路椎间盘镜
手术
体位改进
双节段
疗效
posterior approach microendoscopie discectomy
surgery
position improvement
double segments
clinical effect
