MED经椎板间入路治疗特殊类型腰椎间盘突出症

Translaminar microendoscopic discectomy in the management of special lumbar disc herniation

目的 探讨显微内窥镜椎间盘切除系统 (MED)对 36例特殊腰椎间盘突出症的临床应用价值。 方法 MED配合自制鹅眉凿、骨刀和“L”形骨刀行增生重叠的椎板间开窗、破裂之椎体软骨终板及椎间盘突出钙化切除。 结果 术中硬脊膜撕裂 2例 ,无中转开放手术 ,随访 3月～ 12月 ,Macnab标准优 2 8例 ,良 5例 ,可 2例 ,差 1例 ,优良率 91 7% (33 36 )。 结论 侧卧位下可行MED手术 ;配合自制器械可行破裂的软骨终板及突出钙化的椎间盘切除。

Objective To assess the clinical application of microendoscopic discectomy (MED) system in the treatment of 36 cases of special lumbar disc herniation (LDH). Methods Laminectomy and decompression, and removal of fractured end plate or calcified herniated discs were performed by MED using self-made bone chisel, osteotome and L-shaped osteotome. Results Intraoperative dural laceration occurred in 2 cases, and no conversions to open surgery were required. Follow-up observation ranged (3～12) months (mean, 9.5 months). According to Macnab criteria, 28 patients had excellent, 5 had good, 2 had fair, and 1 had poor outcomes, with good or excellent results in 91.7% (33/36) of the patients. Conclusions MED may be carried out in patients in side position. Calcified herniated discs and fractured end plate can be excised by MED with self-made tools.