后路显微内窥镜椎间盘切除术治疗腰椎间盘突出症的疗效观察

Therapeutic effect observation on posterior microendoscopic discectomy for lumbar intervertebral disc herniation

目的探讨后路经显微内窥镜椎间盘切除术（micro-endoscopic discectomy,MED）治疗腰椎间盘突出症的手术适应证、术中操作特点及相关并发症处理,以提高手术疗效。方法应用椎间盘镜在棘突旁小切口建立工作通道管,经椎板间隙在显微内窥镜下环切突出的纤维环和髓核组织并扩大神经根管。结果术后随访3~12个月,平均6个月,按Nakai O标准疗效评定,其中优12例,良9例,可1例,差1例,优良率为91.3%。术中硬膜囊撕裂1例,因静脉丛出血中转为开放手术1例,无神经根撕裂及切断发生。术后间盘摘除不全,并发马尾综合征1例,二次手术减压内固定融合。术后下床活动时间3~30 d,平均7 d。住院7~40 d,平均12 d。无1例切口感染。结论后路椎间盘镜手术治疗腰椎间盘突出症创伤小,术后康复快,疗效满意,但应严格掌握适应证,熟练的操作技术是减少MED手术并发症、提高其疗效的关键。

Objective To explore the indications,intraoperative characteristics and complication management of posterior micro-endoscopic discectomy（MED）for lumbar intervertebral disc herniation.Methods Microendoscopy was used to establish working tunnel of minimal incision beside spinous process.Annular fibrosus and nucleus pulposus were circumcised to expand nerve root canal through vertebral plate interspace and under microendoscopy.Results Postoperative follow-up time was from 3 to 12 months（averaging 6 months）.The treating effects of 23 patients were evaluated with Nakai′s method.Excellent results were achieved in 12 cases,good in 9,fairly good in 1 and poor in 1,and the first two groups accounted for 91.3%.1 case occurred laceration of dural sac.Because of venous plexus bleeding,the 1 case was transferred to open surgery.There was no nerve root injury.1 case could not be removed with herniated discs completely,and occurred syndrome of cauda equine,and were converted to open operation with decompression,internal fixation and fusion.All incision healed without superficial infection.It took average 7 days for the patients to get off bed,ranging from 3 days to 30 days.Postoperative hospitalization was from 7 to 40 days with an average of 12 days.Conclusion Posterior microendoscopic discectomy is worthy of wide-use due to minimal invasion,quick recovery and good clinical effect.However,appropriate control of indications and skillful surgical technique are keys to decreasing the complication,and improving the curative effect.