脊柱后路显微内窥镜治疗腰椎间盘突出症

Posterior Spinal Approach Microendoscopic Discectomy for the Treatment of Lumbosacral Disc Herniation

目的 探讨脊柱后路显微内窥镜治疗腰椎间盘突出症的临床应用及适应证。方法 采用脊柱后路显微内窥镜椎间盘切除术(microendoscopy discectomy,MED)技术进行髓核摘除及神经根通道清理术。术中通过“C”型臂X线机引导准确定位,仅做长1-8cm 纵行切口,沿导针逐级更换套管扩张后放入金属手术通道及内窥镜镜头,于电视监视下显露椎板间隙,咬除少量椎板下缘及黄韧带,扩大椎间隙, 显露硬脊膜、神经根以及突出椎间盘的髓核组织并予以摘除, 必要时清理或扩大神经根通道。结果 本组共治疗腰椎间盘突出症65 例,随访6～18 个月,按Nakai 标准评定:优49 例,良12 例,可3 例,差1 例。结论 本术式在保证神经根充分减压的基础上,尽量减小手术创伤,保持脊柱后柱完整性,不破坏脊柱的生物力学结构,减少手术对脊柱稳定性的影响。由于手术视野放大15 倍,提高了手术安全性及疗效可靠性。

Objective To investigate the clinical application and indication of spinal microendoscopy for the treatment of lumbosacral disc herniation(LDH). Methods Posterior microendoscopy discectomy(MED) technique was used to remove the nucleus and clean the nerve root canal through an incision of 1 8 cm in length under the guidance of the “C” arm X-ray machine Results Of 65 patients with LDH undergone MED followed up from 6 to 18 months, 49 were evaluated as excellent, 12 as good, 3 as fair and 1 as poor according to the Nakai scale Conclusion The MED led to less trauma and little influence on the stability of the posterior structure of the lumbar vertebrae The procedure was safe and effective in a surgical field of magnification of 15 folds The indications of MED are single LDH or/with narrowed nerve root canal at the same level