后路显微内窥镜配置骨钻和骨刀行腰骶神经根减压术

The microendoscopic discectomy system with manual drill and osteotom for lumbo-sacral nerve root decompresion

目的 :探索扩大脊柱后路显微内窥镜间盘切除 (MED)系统腰骶神经根减压术适应证的技术。方法 :采用MED系统对 10 3例腰骶神经根卡压征患者施术。通过同一后正中切口 (1 8cm)游离皮瓣行两侧减压及工作通道向尾侧或颅侧倾斜行 2～ 3个节段减压 ;配合特制手动骨钻、直式骨刀截骨、椎板间开窗和减压以及“L”形骨刀行椎体后缘硬质骨切除等技术。结果 :1例腰部过胖致手术通道套管未能抵达椎板、另 1例因硬膜囊撕裂较大而改为传统手术 ,余 10 1例均按术前拟定镜下术式得以完成 ,随访半年以上 ,优良率为 93 1%。结论 :MED系统配合骨钻和骨刀可完成绝大多数腰骶神经根卡压征的彻底减压术 ,且效果满意。

Objective:To study the technique and extensive indications for lumbo sacral nerve root decompression using the MicroEndoscopic Discectomy (MED) System.Method:A series of 103 patients with nerve root entrapment syndrome of lumbo sacral spine underwent nerve root decompression using the MED System.Bilateral nerve root decompression through free skin flap,two and three levels decompression through moving the tubular retractor in cranial or caudal direction were performed with the same small skin incision;A laminotomy and root canal decompression were done with the manual drill and streight osteotom specially made and excision of posterior hard bony edge of the vertebrae with 'L' shaped osteotom.Result:The 101 cases underwent the procedure designed preoperitively through the MED System except for two cases,undergoing standard open procedure,one was due to fatty lumbar region where the tubular retractor tip failed to dock on the laminae and the another was due to larger dural laceration.The results showed 93 1% had excellent or good outcomes with a minimum follow up of 6 months.Conclusion:The MED System with manual drill and osteotom specially made may complete most of decompression of nerve root entrapment syndrome of lumbo sacral spine and its result is satisfied.