显微内窥镜下椎间盘切除术治疗腰椎间盘突出症的疗效分析

Analysis of efficacy in microendoscopic discectomy for treatment of lumbar disc herniation

目的:总结经后路显微内窥镜下椎间盘切除术(MED)治疗腰椎间盘突出症的疗效,探索其操作要点。方法:2001年5月～2003年7月对132例腰椎间盘突出症患者采用MED治疗,术中用C型臂X线定位相应节段,建立工作通道,在显微内窥镜下切除部分椎板、黄韧带和少量关节突内缘,牵开硬膜和神经根,显露突出的纤维环和髓核,切除髓核,减压神经根管。采用MacNab腰椎评价标准评价疗效。结果:患者术后平均3d下地活动,平均住院时间8.4d。平均16d生活自理,5周恢复工作。平均随访时间30.5个月,优81例(61.4%),良47例(35.6%)。优良率97.0%。硬膜破裂3例,无神经根损伤。结论:后路MED手术创伤小,患者术后卧床时间短,恢复快,可以取得与开窗手术相近的效果。但需要学习过程,掌握一些要点才能熟练操作。

Objective：To study the clinical results and technical details of mieroendoseopie diseeetomy（MED） for the treatment of lumbar disc herniation.Method：One hundred and thirty-two cases of lumbar disc herniation were operated on with MED from May 2001 to July 2003.For the operation,the location was decided and working channel was built under the “C” arm X-ray intensifier.A fenestration of lamina,removal of ligmentum flavum and slight medial part of the facet were performed endoseopically.After the nerve root and the dural sac were retracted medially,the annulus fibrosus was excised and the nucleus pulposus was removed,The Mac- Nab＇s criteria was used to do the follow-up with the period of 30.5 months.Result：After operation,averagely, the patients were able to walk in 3 days,stayed in the hospital for 8.4 days,managed their daily life in 16 days and resumed to work in 5 weeks.The rate of excellent and good results was 61.4% and 35.6% respectively.3 cases had dural sac rapture.No nerve deficit was happened,Conclusion：MED is minimally invasive surgery.The result is as good as open fenestration surgery with shortened hospital stay and faster return to work.However,the techniques are required of more practice.