内窥镜下保留与不保留黄韧带腰椎间盘摘除术的临床比较研究

The clinical comparison of microendoscopic lumbar diskectomy with and without preservation of the ligamentum flavum

目的探讨在内窥镜下保留腰椎黄韧带的手术技巧、临床适应证和临床效果。方法选择单节段内窥镜下(METRx)腰椎间盘摘除术患者,其中保留黄韧带组65例,同期不保留黄韧带组146例进行临床比较。所有患者均有不同程度腰骶部疼痛伴下肢放射痛,以及不同程度伸拇肌力或跟腱反射减弱,同时辅以CT扫描和(或)磁共振成像(MRI)检查确诊。常规METRx操作下显露腰椎板间隙,用微型手术刀切开并剥离黄韧带,将黄韧带向中线卷曲剥离成上、外、下3面游离的黄韧带瓣,用微型神经拉钩将黄韧带向中线牵开,显露硬膜囊和神经根。椎间盘摘除、神经根松解减压术后,将黄韧带瓣恢复到原来的解剖结构部位。结果两组手术时间和住院时间无差异,但不保留黄韧带组硬脊膜损伤、椎间盘炎及伤口感染及复发率方面较保留黄韧带组高。结论METRx操作下保留腰椎黄韧带技术操作可行,临床效果良好。

Objective To discuss the surgical technique, indication and the clinical effects of the Microscope Endoscopic Tubular Retractor System （METRx） for microendoscopic lumbar diskectomy with the preservation of the ligamentum flavum. Methods Two hundred and eleven patients underwent singlesegment METRx, with ligamentum flavum preservation in 65 patients （Group A）, and without preservation in 146 patients（ Group B）. The two groups were compared clinically. All the patients suffered from low back pain and radicular syndrome to some extent, and the diagnosis was affirmed by CT and/or MRI. After exposed the interlaminar space regularly, the superior, inferior and lateral edge of the ligamentum flavum was released,the 3-sided dissociative ligament pacth was retracted medially during the spinal manipulation and restored anatomically after disc removal and the decompression of the nerve root. Results According to the results of two groups, ligamentum flavum preservation technique was feasible under endoscope and helpful in reducing the scar formation in the spinal canal. Conclusions The ligamentum flavum preservation technique enable the surgeons to preserve the natural barrier. It is feasible to perform METRx, and it is helpful in reducing the epidural fibrosis.