小切口开窗腰髓核摘除术并发症的防治

How to prevent and manage the surgical complications of lumbar disc herniation by small incision fenestration

目的探讨小切口开窗腰髓核摘除术并发症的防治。方法近5年来我们采用小切口开窗髓核摘除术治疗腰椎间盘突出症1685例。结果本组切口均一期愈合,术后出现脑脊液漏3例,刀片断裂1例,腰椎间盘炎2例,术后2年腰椎间盘突出症复发1例。患者随访6个月～5年(平均3.5年),按Nakai分级,优1157例,良496例,可32例,优良率98.1%。结论小切口开窗腰髓核摘除术符合微创外科手术理念,手术保留脊柱中后柱的解剖结构,创伤小,有利于早期功能锻炼,有效防止腰椎节段性不稳、神经根损伤、腰椎间盘炎等并发症,手术安全性高。

Objective Discussing how to prevent and manage the surgical complications of Lumbar Disc Herniation（LDH） by small indision fenestration. Methods The technique of small in- cison fenestration were applied in the operation of 1685 cases of LDH from 2006 to 2011. Results Operative incisions of all these cases were primary healing,no complications of lumbar instability, nerve root injury,incision infection,and epidural hematoma. But 3 cases with cerebrospinal fluid leakage, 1 case with scalpel breakage, and 2 cases with lumbar diseitis. All patients were followed up for six months to 5 years （average 3.5 years）. According to Nakai criteria,the outcomes were excellent in 1157 cases,good in 496, fair in 32,and excellent and good rate were 98.1%. Con- clusion The technique of small incision fenestration applied in the operation of LDH,has the ad- vantage of minimal damage to spinal structrure,small invasive,early postoperative exercise,high safety. And it can effectively prevent complications of lumbar instability,nerve root injury,lumbar discitis.