微创后路椎间盘镜治疗腰椎管狭窄症与腰椎间盘突出症的应用

Lumbar Spinal Stenosis and Lumbar Disc protrusion Treated by Intervertebral Disc Endoscope through Posterior Approach

目的 探讨后路椎间盘镜治疗腰椎管狭窄症与腰椎间盘突出症的临床应用和适应证。方法 采用后路椎间盘镜进行单侧“开窗”减压术与髓核摘除术等。术中通过“C”臂机或摄侧位X线片定位 ,于后正中做1～ 2个长约 1 5cm互不相连的小切口 ,逐级扩张后置入工作通道管 ,钻除部分椎板 ,置入内窥镜 ,于监视器下显露并清除椎板、增生内聚的关节突、肥厚的黄韧带及突出的椎间盘髓核组织 ,彻底解除其对硬膜、神经根的压迫。结果 本组共治疗腰椎管狭窄症 732例 ,随访 3个月～ 3年。按NAKAI标准评定 :优 6 40例 ,良 6 9例 ,可 18例 ,差 5例。优良率为 97%。 3例改行开放式手术治疗。结论 该术式在保证神经充分减压的前提下 ,可减少创伤 ,保持脊柱的稳定性。该方法适用于单节段或多节段腰椎管狭窄症及合并腰椎间盘突出症的患者。

Objective To investigate the clinical application and indications of lumbar spinal stenosis and lumbar disc protrusion treated by intervertebral disc endoscope through posterior approach. Methods Monoside 'fenestration' decompression procedure and nucleus pulposus extirpation were performed by intervertebral disc endoscope through posterior approach. Confirming the location by X-ray during the operation, one or two disconnected small incisions were made in the poster median site. After dilated the incisions gradually, part of the vertebra lamina was drilled off. In order to relieve the compression to dura mater and nerve root thoroughly, hyperplastic articular process, hypertrophic yellow ligament and protruded nucleus pulposus of intervetebral disc were removed under the direction of enodscope. Results 732 lumbar spinal stenosis patients were followed up from 3 months to 3 years after treatment. According to NAKAI criteria, excellent group 640 cases, good group 69 cases, medium group 17 cases, bad group 5 cases. 3 patients were converted to open operation. Conclusion On the premising of sufficient decompression for the nerve, the operation can reduce the degree of trauma and maintain stability of the spine. This method is suitable for the treatment of monosegment or multisegment lumbar spinal stenosis combined with lumbar disc protrusion.