腰椎后路椎间盘镜手术及疗效分析

Clinical results of intervertebral disc endoscope through posterior approach for lumbar disorders

目的分析腰椎后路椎间盘镜手术治疗腰椎间盘突出症和腰椎管狭窄症及椎间盘源性腰痛的特点及临床效果。方法1999年9月～2003年6月,临床诊断为腰椎间盘突出症和(或)腰椎管狭窄症及椎间盘源性腰痛患者1346例,男653例,女693例;平均年龄46.3岁。单纯腰椎间盘突出症159例,单纯腰椎管狭窄症109例,腰椎管狭窄症合并腰椎间盘突出1078例。分别采用腰椎后路椎间盘镜手术进行单节段或多节段、单侧或双侧“开窗”减压、“长槽式”减压及潜行性神经根减压治疗,共切除1794个椎间盘。结果1211例获得随访,随访时间3个月～4年(平均2.5年)。疗效为优1017例(84%)、良170例(14%)、差24例(2%),优良率为98%(其中23例椎间盘源性腰痛和18例青少年腰椎间盘突出症的疗效全部为优或良)。术中出血量为50～600ml,平均250ml。手术时间25min～3.5h。有4例转开放手术,4例行二次后路椎间盘镜手术,发生椎间隙感染7例,脑脊液漏16例,定位错误1例,对侧复发2例。无一例患者术中死亡或发生神经器质性损伤。术后第1天即可下床,1周后基本达到生活自理。结论该术式减压充分,适应证宽、创伤小、出血少、术后恢复快。

Objective To analyse the clinical effects of lumbar disc herniati on, lumbar spinal stenosis and discogenic low back pain treated by the operative procedures of intervertebral disc endoscope. Methods 1346 patients, who were di agnosed as lumbar disc herniation in 159 (including 23 of discogenic low back pa in), lumbar spinal stenosis in 109, and lumbar disc herniation associated with l umbar spinal stenosis in 1078, were treated with translaminar fenestration, tran slaminar notching and undermining enlargement of the neural canal in single or m ultiple segments by intervertebral disc endoscope (Sofamor Danek system and Stor z sysytem) through posterior unilateral or bilateral approach. 1794 intervertebr al discs from L2,3 to L5S1 were excised totally. Results 1211 cases were follo wed up from 3 months to 4 years with an average of 2.5 years. The clinical resul ts were rated as excellent in 1017 cases (84%), good in 170 cases (14%) and poor in 24 cases (2%), and the rate of excellent and good outcomes was 98%, furtherm ore, the excellent or good outcomes were obtained in all 23 cases of discogenic low back pain and 18 cases of adolescent lumbar disc herniation. The blood loss varied form 50 to 600 ml with an average of 250 ml. The operative time ranged fr om 25 minutes to 3.5 hours. 4 cases failed and were converted to open operation. 4 cases, which had undergone lumbar vertebral operation previously, were treate d with intervertebral disc endoscope successfully. In complications, 7 cases suf fered from intervertebral infection, 16 cases dural injury, 1 case wrong locatio n and 2 cases recurrence in the opposite side. No one died, and no nerve injury occured during operation. Patients could get off bed in the first postoperative day, and they could take care of themselves in about one week. Conclusion The p rocedure has more indications and some advantages of minimal invasion, less blee ding, high security, quick recovery on the premise of providing completely decom pression to spinal cord and nerve root.