腰椎后路显微手术治疗腰椎间盘突出的手术要点和并发症分析

Analysis of difficulties and complications during posterior approach lumbar microendoscopic discectomy

目的探讨腰椎后路显微手术(MED)治疗腰椎间盘突出的手术要点及分析手术并发症,达到合理掌握MED的手术适应症,提高手术技巧,减少并发症发生的目的。方法2001年1月至2008年3月,采用MED技术治疗腰椎间盘突出症患者256例,其中32例手术出现并发症,包括2例定位错误,2例定位针直接插入椎间隙,6例遗留游离髓核,6例出现硬膜囊破裂,10例转开放性手术,6例术后发生椎间隙感染。此32例随访3个月至3年以上,疗效:优6例,良12例、差14例,优良率56,2%。结论MED应严格掌握适应症,提高镜下操作技巧,改善对镜下图像的理解,才能获得满意的疗效。

Objective To discuss the features, common problems and complications of microendoscopic surgery by intervertebral disc endoscope through posterior approach for lumbar disc hemiation. Methods Microendoscopic skills were applied to 256 cases of lumbar disc herniation a from January. 2001 to Mar. 2005. Results 10 cases were converted to open operation ,6 cases injured supradurally and 4 cases were located improperly, 6 cases suffered from intervertebral infection. The 32 cases were followed up from 3 months to 3 years. The clinical results were rated as excellent in 6 cases, good in 12 cases and poor in 14 cases. The rate of excellent and good outcomes was 56. 2%. Conclusion The procedure has the advantages of minimal invasion, thorough decompession and quick recovery. The key of improving operation and reducing complications is to select the indications and perfect its techniques.