后路显微内窥镜手术治疗腰椎间盘突出并发症

Postero-way Microendoscope Operation to Treat Intervertebral Disk Protrusion Complication

目的探计后路经显微内窥镜椎间盘切除术治疗腰椎间盘突出症的手术适应训术中操作要点及并发症处理。方法回顾性分析2000年7月-2005年3月应用MED手术治疗的腰椎间盘突出症患者312例，男207例，女105例；年龄16～74岁，平均34岁。术前均行CT检查，常规扫描13-S1三个椎间隙。148例术前行MRI检查。检查结果为单节段椎间盘突出198例，双节段椎间盘突出86例，三节段椎间盘突出28例。手术切除单节段252例，双节段56例，三节段4例。结果术后2～6d下床活动，平均4d。术后住院3～14d，平均6，2d。全部病例随访2～48个月，平均16个月。术后平均4—6周基本恢复正常生活和一般工作，优213例、良74例、可20例、差5例，优良率92％。术中发生硬膜及神经根袖损伤6例，椎间隙定位错误1例。术后椎间隙感染7例，感染率2．2％，并发症率为4．4％。结论严格掌握适应证、熟练的操作技术是减少MED手术并发症、提高其疗效的关键。

Objective To explore the operation indication and the important points in operation and complication disposal of postero- way（ microendoscopeo discectomy, MED） to treat the intervertebral disk protrusion. Methods By retrospective analysis use MED operation to treat inervertebral disk protrusion patients 312 cases, male 207 cases, female 105 cases, ages 16 - 74 years old, average 34 years old from July 2000 to March 2005. All take CT examination before the operation. General scan the three intervertebral lacunae between L3 - S1. 148 cases take MRI examination before operation. The resuits are uniondale intervertebral disk protrusion 198 cases, biarticulate intervertebral disk protrusion 86 cases, and triarticular intervertebral disk protrusion 28 cases. Operation excision the uniondale 252 cases, biarticulate 56 cases, triarticular 4 cases. Results The patients could do normal activity without bed after operation in next 2 -6 days ,average 4 days. Stay in hospital 3 - 14 days after operation ,average 6. 2 days. The follow - up ranging from 2 months to 48 months, average 16 months. Average 4 - 6 weeks restore normal living and working,advance 213 cases, good 74 cases, commonly 20 cases,fail 5 cases ,the rate of pass is 92%. The dura damage and the nerve root and neuraxis damage 6 cases in operation, intervertebral lacunae infection 7 cases, the infection rate is 2.2%, and the complication rate is 4.4%. Conclusion Severeling masteriny indication, adroit operation technique are key to reduce complications of MED operation and improve the effection.