摘要
目的探讨后路经显微内窥镜椎间盘切除术(microendoscopic discectomy,MED)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.方法回顾性分析2000年3月～2002年3月应用MED手术治疗的腰椎间盘突出症患者242例,男171例,女71例;年龄19～71岁,平均34岁.术前均行CT检查,常规扫描L3～S1三个椎间隙.48例术前行MR检查.检查结果为单节段椎间盘突出193例,双节段椎间盘突出46例,三节段椎间盘突出3例.手术切除单节段205例,双节段36例,三节段1例.结果术后1～6 d下床活动,平均2.2 d.术后住院3～12 d,平均5.2 d.切口浅层感染1例,经换药后二期愈合.全部病例随访2～15个月,平均6个月.术后平均3.6周基本恢复正常生活和一般工作,恢复原工作率52.4%.按Macnab疗效评价标准,优183例、良44例、可13例、差2例,优良率94%.术中发生硬膜及神经根袖损伤6例,椎间隙定位错误1例.术后椎间隙感染1例,经卧床制动、理疗和抗生素治疗后痊愈.结论严格掌握适应证、熟练的操作技术是减少MED手术并发症、提高其疗效的关键.
Objective To explore the indications, intraoperative problems and management of its complications of the microendoscopic discectomy (MED) in the treatment of lumbar intervertebral disc herni-ation through posterior approach. Methods 242 cases of lumbar disc herniation treated by MED were re-viewed retrospectively from March 2000 to March 2002. Of the 242 cases, there were 171 males and 71 fe-males aged from 19 to 71 years with an average of 34 years. Among them, the lesions were located at single level in 193, double levels in 46, and three levels in three. All of 242 patients were examined with CT, 48 of which were performed MR. Results 205 herniated discs of the single level were removed, 36 of the double levels, and one of the three levels. It was average 2.2 days for the patients to get off bed ranging from 24 hours to 6 days. Postoperative hospitalization was from 3 to 12 days with an average of 5.2 days. Among the intraoperative complications, dural tear happened in four, nerve root injury in two, and mistakes of localiza-tion in one. While in postoperative complications, there was discitis in one which happened at three weeks postoperatively, and was cured with antibiotics and ambulation for five months. All incision healed in one stage, except one suffered from superficial infection and healed by dress changing. All cases were followed up for 2 to 15 months with an average of 6 months. The average period for the patients retuning to daily life was 3.6 weeks, and 52.4% of the patients restored to previous work. According to Macnab's evaluation sys-tem for clinical outcomes, the results showed excellent in 183, good in 44, fair in 13 and poor in two, so the rate of excellent and good was 94%. However, there were two cases converted to open operation because of compressive neurological dysfunction. Conclusion Appropriate control of indications and skillful surgical technique are the key points to decrease the complication, and to improve the curative effect.
出处
《中华骨科杂志》
CAS
CSCD
北大核心
2004年第4期249-252,共4页
Chinese Journal of Orthopaedics
