椎间孔镜微创术治疗腰椎间盘突出症90例疗效观察

The Transforaminal Mirror Minimally Invasive Surgery for Lumbar Disc Herniation 90 Cases

目的观察与探讨椎间孔镜微创术治疗腰椎间盘突出症的优势。方法选择腰椎间盘中央型、旁中央型突出物〉3mm、症状明显、影像典型病例90例,将之分为＂孔镜治疗组＂即治疗组,与＂常规治疗组＂即对照组。治疗组的治疗方法是：L4~5突出多用侧路镜术、L5~S1突出用后路镜术,在C型臂X线导引下,针对病灶靶点建立工作通道,用6.3mm直径的耐三氧的椎间孔镜,在镜下进行钳夹术、等离子体消融气化术、三氧注射术、摘除其突入骨性椎管的游离型或包裹型的髓核。结果椎间孔镜微创疗法与常规疗法相比,其疗效有明显提高,P〈0.01,且安全系数高,所以全部病例都没有发生负面损伤与感染。结论治疗组较好疗效的作用机制,主要是摘除了突出的髓核组织;调整了纤维环的张力失衡;减轻了椎间盘内的压力,缩小或消除了挤压病灶;并能调整纤维环、肌肉、软组织的力矩;增加脊神经根活动度,从而能有效地解除患者的疼痛麻木症状。

Objectives To observe and approach the superiority for treating lubar intervertebral disc protrusion（LIDP）with anterior foramina vertebrascope.Methods Choosing the typical image cases 90 with obvious symptoms;the lubar intervertebral disc in the central type、 beside the central type,protruding 3mm bigger.Then they are divided into two groups： treatment part with anterior foramina vertebrascope,comparative part with conventional therapy.The methods：L4~5protrusion,taking More the bypath intervertebrascope.L5-S1protrusion,taking the backside intervertebrascope Under the guide of C-type arm X ray,building up the operation path for focal target.By 6.3mm diameters anterior foramina vertebrascope,taking the clamping,the plasma melting,trioxide injection,excising nuclei pulposus in episomal encapsulated types.Results Comparing with the two groups,the curative effect of anterior foramina vertebrascope has obviously increased,P0.01,with high safety factor,consequently,no negative injury and infection.Conclusion The better mechanism of action of curative effect for the treatment part,mainly excising the protruding nuclei pulposus tissue;adjusting the force of dystonia of fibrous ring;releasing the pressure of lubar intervertebra disc,shrinking or removing the focal;adjusting the force of dystonia of fibrous ring,muscle,soft tissue;increasing the activity of spinal nerve root,as a result,these effectively relieve symptoms of the aching and numbness.