椎板间隙入路椎间盘镜治疗腰椎间盘突出症并侧隐窝狭窄的初步报告

Microendoscopic (MED-Ⅱ) discectomy for treatment of lumbar disc herniation with stenosis of lateral recess

目的探讨椎间盘镜技术治疗腰椎间盘突出症并侧隐窝狭窄的手术技术、临床效果及适应证选择。方法硬膜外麻醉下借助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,扩大并清理神经根通道,摘除突出椎间盘髓核组织。结果临床疗效参照Nakai分级,68例患者均获得随访,平均27个月。其中优49例(72.1%),良12例(17.6%),可7例(10.3%),优良率为89.7%。结论MED手术是治疗腰椎间盘疾病安全有效的方法,具有视野清晰、创伤小、恢复快、对脊椎后柱稳定破坏小等优点,随临床经验积累和手术技巧提高,MED-II手术适应证不断扩大。

[Objective] To evaluate the clinical technique, clinical effects and the indication of microendoseopie （MED-Ⅱ） discectomy for the treatment of lumbar disc herniation with stenosis of lateral recess. [Methods] After the local anesthesia, the surgical approach was under the guidance of C-Arm computed and the monitor of fluoroscope. The lateral access was enlarged by resecting the thickened ligamentum flavum and the hyperplastic articular process. The nerve root canals were cleaned and the nerve roots were decompressed thoroughly. Finally, the herniarea disc were removed successfully. [Results] Clinical outcomes were determined using NaKai criteria and 68 cases of lumbar disc herniation were treated by the MED- Ⅱ technique and followed up for a mean duration of 27 months. 49 were evaluated as excellent, 12 as good, and 7 as fair. The excellent and good rate was 89.7%. [Conclusions] The MED-Ⅱ discectomy is an enough safe and effective method for the treatment of lumbar disc herniation. And it has lots of advantages such as clear surgical field, less trauma, early recovery and less influence on the stability of the posterior structure of lumbar spine. The indication of MED-Ⅱ discectomy will be expanded with the enhancement of clinical experience and operation technique.