经脊柱后路椎间盘镜治疗腰椎间盘突出症并发症分析

Intraoperative complications in lumbar disc surgery with micro endoscopic discectomy (med)

目的 探讨经脊柱后路椎间盘镜手术治疗腰椎间盘突出症并发症的原因，总结教训，提出预防措施。方法 对2002年3月～2008年3月860例（962个间隙）显微椎间盘镜腰椎间盘切除术（micriendoscopic discectomy，MED）中30例手术并发症进行总结。结果 中转开放手术16例，脑脊液漏4例，神经根损伤1例，定位错误6例，术后椎间隙感染3例。中转开放手术者，由于术中出血多果断中转而治愈；脑脊液漏及椎间隙感染经治疗已治愈；定位错误者二期再行后路椎间盘切除术；神经根损伤1例，经治疗残留部分感觉减退及踝下垂。结论 经脊柱后路椎间盘镜治疗腰椎间盘突出症比常规手术创伤小，恢复怏，基本保持了脊柱后路完整，对脊柱稳定一崖影响小，手术视野清晰，手术安全，疗效可靠，但必须手术操作规范，熟悉解剖，提高手术技巧，才可避免神经根损伤等并发症的发生。

Objective To investigate tile causes and the prevention of intraoperative complications in posterior apporach micro endoscopic discectomy （ MED）, Methods From March 2003 to March 2008,860 cases（ 962 intervertebral disks） v, rere treated with MED, 30 cases had intraoperative complications. Results Of the 30 patients, 16 suffered from transference to open operations, 4 from cerebrospinal leak, 1 from nerve root injurie ,6 from localization errors ,3 from infection of intervertebral spaces. The causes of transferrence to open operation was massive bleeding. The cases of cerebrospinal leak and intervertcbral spaces infection cured after combined modality therapy .The localization error cases treated with selective operation of posterior approach disecetomy. The nerve root injury cases have had residual hypesthesia and ankle drop. Conclusion Posterior approach MED to treat ubar intervertebral disc protrusion has advantages of less surgical trauma than routine operation,, recovery quick,, keep the integrity of spinal column posterior approach essentially, has little effect to spinal stabilizatlon,.clear operating field、safe、reliable therapeutic effect. But it need standardize operative procedure,be familiar with dissection, improve surgery skill, and that would avoid the complications such as nerve root injuries.