腰椎间盘突出症合并椎管狭窄23例治疗分析

Analysis of Lumbar Disc Herniation with Lumbar Spinal Stenosis Treated by Microendoscopic Discectomy System

目的探讨经后路椎间盘镜手术治疗合并腰椎管狭窄症的椎间盘突出症的临床应用。方法采用后路椎间盘镜进行单侧开窗减压术。通过术前标记腰椎正侧位片定位,于定位棘突间隙后正中偏患侧作长约1.5 cm小切口,逐级扩张后置入工作通道管,钻除部分椎板,置入内窥镜,于电视监视器下显露椎板、增生内聚的关节突、肥厚的黄韧带及突出的椎间盘髓核组织,彻底解除其对硬脊膜、神经根的压迫。结果本组共治疗合并腰椎管狭窄症的腰椎间盘突出症23例,平均随访7个月,按Prolo标准评定,治愈20例,有效2例,无效1例。结论本术式在严格掌握适应证前提下对合并腰椎管狭窄症的腰椎间盘突出症患者效果明显。

Objective To investigate clinical application and indication of posterior spinal approach microendoscopic discectomy system（MED）. Methods MED was used to remove the elements（bony and disc） that were compressing the dural sac and nerve roots through an incision 1.5 cm length at the interspace of spinal process determined by the finished X-ray photograph of lumber vertebrae. Results 23 LDH patients with lumbar spinal stenosis undergone MED were followed up for 7 months, 20 were evaluated as excellent, 2 as good, 1 as failure. Conclusion The MED leads to less trauma to lumbar vertebrae and little influence on the stability of it. With strict selection of indication of MED for lumbar disc herniation with lumbar spinal stenosis, The evaluation of operation is excellent.