椎间盘镜下椎间盘摘除术并发症的处理和预防

Complications following microendoscopic discectomy: Management and prevention

目的总结115例椎间盘镜下椎间盘摘除术的经验教训。方法回顾分析我院2001年4月～2003年4月椎间盘镜下椎间盘摘除术并发症的原因及处理。结果中转开放手术13例,术中椎间盘镜移位2例,硬脊膜损伤7例,术后血肿压迫神经2例,无神经根损伤。全组随访3～12个月,平均75月,按Nakai分级优70例,良36例,可7例,差2例,优良率922%(106/115)。结论合理选择适应证、术中C形臂X线机定位、黄韧带及椎板切除、神经根周围粘连分离显露充分、彻底止血是减少并发症的关键。

Objective To summarize the experience of microendoscopic discectomy (MED). Methods A retrospective analysis was made on causes and the management of complications following 115 cases of MED in this hospital from April 2001 to April 2003. Results A conversion to open surgery was required in 13 cases. There were 2 cases of endoscope displacement and 7 cases of dural abruption intraoperatively. Postoperative hematoma pressing on neighbouring nerves was seen in 2 cases but no nerve root injuries were found. All the patients were followed for 3～12 months (mean, 7 5 months). According to the Nakai scale, 70 cases were classified as “excellent”, 36 cases “good”, 7 cases “fair”, and 2 cases “poor”, the “good” or “excellent” rate being 92.2% ( 106/115 ). Conclusions Proper selection of patients, intraoperative localization by “C”-arm X-ray examination, removal of the ligamenta flava and the lamina, detachment of adhesions surrounding the nerve root to obtain a complete exposure, and thorough hemostasia are crucial to minimize the incidence of complications.