后路椎间盘镜手术中转传统开窗椎板切除髓核摘除术的原因分析

The causes of conversion to traditional fenestration laminectomy discectomy for microendoscopic discectomy

目的分析后路椎间盘镜(MED)治疗腰椎间盘突出症术中转传统开窗椎板部分切除髓核摘除术的原因,探讨相应的预防措施。方法分析应用MED技术治疗300例(342个间隙)患者的临床资料,总结9例中转开窗椎板部分切除髓核摘除术的原因,并提出相应的预防措施。结果 300例患者手术切口均一期愈合。疗效评定:优148例,良130例,中18例,差4例,优良率为92.7%。中转开窗椎板部分切除髓核摘除术9例:3例术中出血多者果断中转而治愈;5例脑脊液漏者经治疗治愈;1例神经根损伤开放探查,为部分马尾损伤,经治疗残留部分感觉减退但无足下垂。结论硬脊膜损伤、术中出血、神经根损伤是MED治疗腰椎间盘突出症中转传统开窗椎板部分切除髓核摘除术的常见原因;术者丰富的微创经验、合适的病例选择可减少MED治疗腰椎间盘突出症中转开窗椎板部分切除髓核摘除术。

Objective To analyze the causes of conversion to traditional fenestration laminectomy discectomy for mi- croendoseopic diseectomy. Methods 300 eases （342 intervertebral disks） were analyzed retrospectively. The causes of intraoperative 9 cases conversion to traditional fenestration laminectomy disceetomy were summarized, and the effec- tive preventions were also analyzed. Results 300 cases got primary surgical wound healing, Evaluation of clinical effect：148 cases were excellent,130 good,18 fair, and 4 poor,and the excellent and good rate was 92. 7%. 9 cases were converted to traditional fenestration laminectomy discectomy, including 5 cerebrospinal leakage, 3 massive bleed- ing, and 1 nerve root injury. The bleeding was controlled. The cases of cerebrospinal leak cured after combined modal- ity therapy. 1 nerve root injury got eauda equina repaired, recovered with some sensor defect without foot drop. Con- clusions Dural injury, intraoperative bleeding, nerve root injury are common causes of conversion to traditional fen- estration laminectomy discectomy for microendoscopic discectomy. Rich experience in minimally invasive, suitable pa- tients selection can be effective in preventing complication of posterior microendoscopic discectomy.