摘要
目的探讨椎间盘镜下椎间盘切除术(microendoscopic discectomy,MED)治疗破裂型腰椎间盘突出症的临床效果。方法 2005年6月～2009年12月77例无明显腰椎不稳的破裂型椎间盘突出症,病变椎突旁0.5 cm处做1.5～2.0cm纵行切口,适当剥离上椎板下缘肌肉,逐级套入椎旁肌扩张管,连接工作通道,安装MED系统。清理工作窗口内软组织,椎板咬骨钳切除部分上椎板,显露黄韧带附着点,剥离并咬除外侧部分黄韧带,显露神经根,髓核钳取出破裂的髓核组织,清理椎间隙和椎管内髓核组织。结果手术时间25～90 min,平均45 min。出血量10～150 ml,平均25 ml。Oswestry功能障碍指数(Oswestry disability index,ODI)术前(39.61±1.92)分显著高于术后1个月(7.25±1.31)分(t=6.725,P=0.000)。77例随访9～36个月,平均23个月,未发生椎间隙感染及术后明显椎体滑脱。术后6个月Macnab评价标准:优56例,良15例,可5例,差1例,优良率达92.2%(71/77);65例术后随访超过1年,按Macnab评价标准:优51例,良11例,可2例,差1例,优良率95.4%(62/65)。结论 MED是治疗破裂型腰椎间盘突出症的一种有效的方法,具有损伤小、恢复快、并发症少的优点,疗效满意。
Objective To evaluate the efficacy of posterior microendoscopic discectomy（MED） for non-contained lumbar intervertebral disc protrusion. Methods From June 2005 to December 2009,77 patients with non-contained lumbar intervertebral disc protrusion without lumbar unsteadiness,received MED in our hospital.A 1.5-to 2.0-cm longitudinal incision was made at 0.5 cm away from the lesion,and then the muscle attached to the inferior vertebral plate was stripped so that to insert dilation tube,build operation channels,and connect MED system.To clear the soft tissues in the operation port,we partially resected the upper vertebral plate with a laminectomy rongeur,so that to expose the attachment point of the arcuate ligament and strip and resect the lateral part of the arcuate ligament to expose the nerve root.After that,the ruptured nucleus pulposus was removed and the intervertebral space and vertebral canal were cleared. Results The mean operation time was 45 min in our series（25-90 min）,and mean intraoperative blood loss was 25 ml（10-150 ml）.The mean Oswestry Disability Index（ODI） of the patients decreased significantly from 39.61±1.92 preoperation to 7.25±1.31 one month postoperation（t=6.725,P=0.000）.The 77 patients were followed up for 9 to 36 months with an average of 23 months,during which no infection nor vertebra slippage occurred.According to Macnab＇s criteria,56 patients achieved excellent outcomes,15 good,5 fair,and 1 poor.The excellent and good rate was 92.2%（71/77）.Among the patients,65 achieved a follow-up for over one year,which showed an excellent and good rate of 95.4%（62/65,excellent 51 cases,good 11 cases,fair 2 and poor 1）. Conclusion MED is an effective and less-damage treatment for patients with non-contained lumbar disc herniation with quick recovery and few complications.
出处
《中国微创外科杂志》
CSCD
2012年第1期61-63,共3页
Chinese Journal of Minimally Invasive Surgery
关键词
腰椎间盘突出症
椎间盘镜下椎间盘切除术
髓核摘除术
Lumbar intervertebral disc protrusion
Microendoscopic discectomy（MED）
Nucleus pulposus discectomy
