腰椎间盘三维形态学与后路椎间盘镜手术的临床研究

Clinical study of three dimensional morphology of disc lumbar her niation and microendoscope assisted posterior discectomy

目的 通过腰椎间盘三维形态学观察 ,提高显微内窥镜下椎间盘突出髓核摘除术 (MED)的应用价值。方法 观察腰椎间盘及其邻近结构的三维形态 ,分析神经根、硬膜囊受压的原因和范围 ,设计腰椎间盘镜下专用手术器械 :骨刀、骨镫 ,完成腰椎间盘突出髓核摘除、局限性腰椎管扩大减压术 110例。结果 统计 90例 116个节段腰椎间盘突出症在横断位 4种形态、矢状位 3种形态、冠状位 3种类型 4种位置及其邻近病变对硬膜囊、神经根的 7种影响 ;110例手术经 1～ 2 5个月随访 ,按Macnab疗效评定标准 :优 80例、良 2 4例、可 6例、差 0例 ,优良率 96 .1%。结论 腰椎间盘三维形态学可全面表达各种类型腰椎间盘突出症及邻近病变对神经组织压迫的性质、部位、程度 ,为临床提供疾病的病理解剖学基础和术前评估、入路指导及整体手术设计的依据 ;针对性添制特殊器械后 ,运用后路腰椎间盘镜手术可治疗腰椎间盘突出症及局限性椎管狭窄 ,但须严格掌握手术指征。

Objective To expand the application scale of microendoscopyassisted posterior discectomy under the study of threedimensional reconstruction morphology of lumbar disc herniation (LDH) using spiral computed tomography. Methods By analyzing the threedimensional morphology of LDH and the relationship between the LDH and its adjacent structure, such as the nerve root and epidural, 110 patients had been taking microendoscopeassisted discectomy and local vertebral laminectomy with some selfmade instruments proper to the operation. Results The characteristic threedimensional morphology of LDH from 116 segments of 90 cases was analyzed, that four kinds at cross section, three kinds at sagital plane, and three kinds at coronal plane could be recognized; it could also recognize that there were seven ways of how the involved area of segments effected on the dural bladder and the nerve root. On the follow up visit to 110 patients from one month to 25 months, being 12 months on the average, 80 cases got excellent and 24 cases got good results, six cases being passable, with the ratio of excellent and good results attaining to 96.1%, according to the Macnab scale. Conclusion The three dimensional morphology of LDH using spiral computed tomography is a good method, which could overall reveal different kinds of LDH and reveal how the adjacent involved area effecting on the nerve root pressed, including the character, the region and the degree, etc.It could therefore provide the clinical anatomicopathological foundation to instruct the preoperative evaluation, the surgical approach, and a comprehensive planning for the microendoscope assisted discectomy. By designing and manufacturing some proper instruments, the indications can be further enlarged.