后路椎间盘镜手术治疗腰椎管狭窄症

The posterior operative method of MED in the treatment of lumbar ertebral canal stenosis

[目的 ]探讨后路椎间盘镜手术治疗腰椎管狭窄症的方法。 [方法 ]本组 2 3例术前通过患者的症状和体症及影像学检查确定腰椎管狭窄的间隙 ,明确受压的具体神经 ,以制定手术建立通道的部位和数量。手术通道的皮肤切口距中线 1cm为宜 ,中心点位于椎板间隙 ,通过上下平移工作通道及改变其角度 ,显露一侧椎板上下缘黄韧带及关节突。选择性切除部分椎板上下缘 ,切除黄韧带 ,对增生肥大内聚的关节突予以切除 ,尤其对椎板上缘与上关节突移行部上份重点切除 ,以此切除椎管狭窄之后方压力部。神经根管前壁椎体后缘较大的骨赘应予切除或用嵌入器砸平 ,对膨出椎间盘视硬膜囊波动及神经根的滑动范围决定是否切除。[结果 ]2 3例经 5～ 10个月随访 ,按 Nakai等标准评定 ,优 19例 ,良 3例 ,可 1例 ,优良率 96 .6 5 %。[结论 ]后路椎间盘镜手术治疗腰椎管狭窄症既能达到减压目的 ,又因其特有的微袭技术 。

Explore the posterior operative method by using microendo scopic discectomy(MED).There were 23 cases in this group.We verified the stenosis site through symptoms,signs,CT or MRI,and distinguished the depressed nerve roots.Through these results,we were then able to make the appropriate operative procedures.The operative access was 1cm away from the centerline;the center point was in the clearance.To uncover one side of the lamina,we moved the work pipe up and down while changing the angle of pipe.Then,we excised part of lamina edge,Lig,Flava,dystrophy articular process,and osteophytes.We also excised the junctions between the upper edge of the lumina and the upper articular process,which can depress the posterior part of stricture.The osteophytes between the nerve roots canal and posterior edge of the vertebrae should be excised or smoothed by apparatus.Whether to excise the protrusion disc or not is decided upon the dural and nerve root tension.All 23 cases were followed for up to 5~10 months.Scored by Nakai system,the reasults concluded 19 excellent cases,3 good cases,and 1 common case.The success rate was 96 65%.[Conclusions] Treat lumbar vertebral canal stenosis with MED.Not only can it depress the spine canal,but also it has the advantage of stabilizing the lumbar spine for its micro injure.