小切口髓核摘除术切口定位及病变间隙的确认

Localization of Incision and Herniated Space during Discectomy through Small Incision

目的：准确的皮肤切口定位和突出间隙的确认是小切口椎间盘摘除术的成功关键之一。方法：我们对５３８例腰椎间盘突出症病人行过小切口椎间盘摘除术。术前我们采用：读、摸、按相结合的皮肤切口定位法，术中又用摸、摇、触相结合的办法对突出间隙进行再确认。结果：定位准确率可达１００％。避免了使用单一固定的解剖关系定位法所可能造成的定位错误。结论：该方法是利用病人腰椎的正常解剖结构，结合病人病椎的病理变化特点，同时又考虑到病人解剖变异的可能而设计的临床定位法。它对小切口椎间盘突出摘除术有一定的临床指导意义。

Aim:One of the most important factors for successful discectomy through small incision is localization of incision and herniated space.Methods:In 538 patients,with prolapse of lumbar disc were operated,a combined procedure of reading,palpating and pressing was employed preoperatively for localization of incision.Further palpating,mobilization and touch were carried out intraoperatively for confirmation of the herniated space.Results:The accurate rate of localization was 100%.Conclusion:Some false localizations,resulted from using anatomical positioning skills only,may be avoided by using the conbined procedures.These procedures are designed based on the normal anatomy,pathologic changes and individual variation of lumbar spine,and may be considered as a guide for discectomy through small incision.