提高自动经皮穿刺腰椎间盘切吸术成功率的作法和体会

The Experience on Increase the Successful Rate of Automatic Percutaneous Lumbar Discectomy

目的：为了改进麻醉和手术方法，明确适应证，进一步提高自动经皮穿刺椎间盘切吸术治疗腰椎间盘突出症的成功率。方法：我们应用局部浸润麻醉方法，采用“直角等腰三角形定位法”为４１例腰椎间盘突出症患者进行了自动经皮穿刺腰椎间盘切吸术，其中Ｌ４－５３６例，Ｌ５Ｓ１５例。术后随访６～２４个月，平均１８．４个月。术中及术后应用抗生素及康复治疗。结果：４０例术后即恢复良好，优良率９７．３％。１例因术前忘记定位，术中反复穿刺，致术后腰痛、下肢麻木，半个月后完全缓解。平均住院１１天，无一例复发，均恢复原工作。结论：严格选择适应证、准确的定位、熟练的椎间盘穿刺技术、严格的无菌操作和术后康复锻炼是提高经皮穿刺腰椎间盘切吸术成功率的关键。

Object: To improve the method of anesthesia and operative technique to increase the successful rate of automatic percutaneous lumbar discectomy (APLD).Method: Local anesthesia was selected and an  isosceles right angle triangle method ” was used to localize the pin angle and position. Forty_one cases with lumbar disc herniation, including 36 cases of L 4- 5 and 5 of L 5S 1, were treated with APLD. Results: With an average of 18.4 months follow_up, the rate of excellent and good was 97.3% .Conclusion: Strictly selected indication, accurate localization, skillful manipulation and post_operative rehabilitation are the key to increase the successful rate of the APLD.