椎板间隙后路显微内镜治疗腰椎间盘突出症724例

Microendoscopic (MED-Ⅱ) discectomy via posterior lamina for treatment of the lumbar disc herniation-a report of 724 cases

目的 报道经后路椎板间隙显微内镜 (MED Ⅱ手术 )治疗腰椎间盘突出症的手术技术、临床效果及适应证选择。方法 局麻或持硬膜外麻醉下 ,床旁C 臂机定位 ,沿导针依次扩张 ,置放手术通道和内镜 ,电视监控下扩大后路椎板间隙 ,咬除局部增生内聚小关节及增厚黄韧带 ,扩大及清理神经根通道 ,摘除突出椎间盘髓核组织。结果 MED手术共 72 4患者 ,86 7腰椎间盘 ,平均住院时间 16 .8d。平均手术出血量 4 5ml。平均手术时间 5 8分钟。疗效优良率达 93.2 %。结论 MED手术比常规手术创伤小 ,恢复快 ,基本保持了脊柱后柱完整 ,对脊柱稳定性影响小 ,手术视野清晰 ,手术安全 ,疗效可靠。随临床经验积累和手术技巧提高 ,MED

Objective To evaluate the clinical technique,clinical effects and the indication of microendoscopic(MED-Ⅱ) discectomy via posterior lumbar lamina.Methods After the local anesthesia, the surgical approach was under the guidance of C-Arm computed and the monitor of fluoroscope. The lateral access were enlarged by resecting the thickened ligamentum flavum and the hyperplastic articular process.The nerve root canals were cleaned, and the herniatea disc were removed. Finally, the nerve roots were decompressed thoroughly. Results The 724 cases including 867 lumbar interverterbral spaces were treated successfully by the MED-Ⅱtechnique.The average hospital stay was 16.8 days,including the average operation time of 58 minites, and the average volume of bleeding was 45 ml. 93.2% of the patients gain excellent results. Conclusions The MED-Ⅱassisted discectomy via posterior lamina is much more safe to operate and effective because of its clear surgical field, having less trauma, and less influence on the stability of the posterior structure of lumbar spine