内窥镜下保留大部分黄韧带治疗腰椎间盘突出症

Treatment of lumbar intervertebral disc protrusion and remaining bulk ligamentum flava by micro-endoscope

目的:探讨内窥镜下保留大部分黄韧带治疗腰椎间盘突出症的手术技巧和近期临床效果。方法:52例腰椎间盘突出症患者,男31例,女21例;年龄28～45岁,平均36岁;其中L4,524例,L5S128例。在内窥镜操作下,咬除上位椎板下缘1/4～1/3骨组织,纵向扩大骨窗,角度小刮匙在下位椎板上缘外侧分离出浅层黄韧带,用咬骨钳沿椎板上缘横行咬除浅层黄韧带成一小凹槽,用髓核钳在凹槽处钳夹黄韧带浅层向近端牵拉剥离并切除,保留深层黄韧带,然后用椎板咬骨钳在黄韧带外侧咬除小关节内侧1/4～1/3,扩大侧隐窝,游离黄韧带外缘,椎板咬骨钳咬除黄韧带外侧1/3入椎管,保留内侧2/3,神经根钩仔细分离突出椎间盘周围的组织,尽可能保留神经根周围及硬膜外脂肪,将硬脊膜及神经根牵向内侧,摘除突出的髓核。结果:52例中46例获得随访,随访时间5～51个月,平均34.5个月。疗效评定按Nakai标准,优34例,良9例,可3例。手术时间45～75min,出血40～80ml,均无神经根损伤和硬脊膜撕裂等并发症。结论:内窥镜下保留大部分黄韧带,技术上操作可行且尽可能的保留了人体的自然解剖结构,最大限度地维持了脊柱的稳定性,临床效果好。

Objective：To investigate operative skill and recent clinical effects of remaining bulk ligamentum flava and treatment of lumbar intervertebral disc protrusion by micro-endoscope. Methods：Fifty-two cases with lumbar intervertebral disc protrusion included 31 males, 21 females;aged from 28 to 45 years, mean 36 years ;L4.5 in 24 cases, L5S1 in 28 cases. Under the micro-endoscope, all patient were excised the vertebral plate partly, decompressed the nerve root, remaining bulk ligament flava and excised the herniated nucleus pulposus. Results：Forty-six of 52 patients were followed up for 5 to 51 months with an average of 34.5. According to the effect of Nakai standards,the results were excellent in 34 cases,good in 9 cases ,fair in 3 cases. The operation time was 45 to 75 minutes and bleeding was 40 to 80 ml. There were no nerve root injury and endorachis tear complications. Conclusion：The bulk ligamentum ftava remaining cure intervertebral disc protrusion by micro-endoscope, demic natural anatomic structure is retained through technically manipulate and spinalis constancy is kept.