脊柱后路椎间盘镜治疗腰椎间盘突出症初步观察

Posterior spinal approach microendoscopic discectomy for the treatment of lumbosacral disc herniation

目的 :介绍并采用第二代后路椎间盘镜 (MED、METRX)手术系统治疗腰椎间盘突出症。方法 :采用后路椎间盘镜技术进行髓核摘除及神经根通道清理术。术中通过“C”型臂 X线机引导准确定位 ,仅做长 1.6 cm纵行切口 ,沿导针逐级更换套管扩张后放入金属手术通道及内窥镜镜头 ,于电视监视下显露椎板间隙 ,咬除少量椎板下缘及黄韧带 ,扩大椎间隙 ,显露硬脊膜、神经根以及突出椎间盘的髓核组织并予以摘除 ,必要时清理或扩大神经根通道。结果 :本组共治疗腰椎间盘突出症 15例 ,男 8例 ,女 7例 ,平均 37.9岁。随访 6～ 12个月 ,按 Nakai标准评定 :优 12例 ,良 3例 ,无神经根损伤及硬膜囊撕裂病例。结论 :MED、METRX用于椎间盘突出症的治疗具有安全、损伤轻微 ,恢复快等优点 ,能准确摘除突出椎间盘 ,能切除增厚的黄韧带 ,修整增生的关节突以扩展侧隐窝解除神经根压迫。随手术操作技巧的提高 ,适应证能扩大 ,并发症能减少 ,是治疗椎间盘突出症的一种值得临床推广的新技术。

Objective: To introduce and use a second generation of Microendoscopic discectomy(MED) for the treatment of lumbar disc herniation(LDH). Methods: Posterior microendoscopy discectomy(MED) technique was used to remove the nucleus pulposus and clean the nerve root canal through an incision of 1.6cm in length under the guidance of the 'C' arm X-ray machine. Results: Of 15 patients with LDH who took MED followed up from 6 to 12 months, 12 were evaluated as excellent, 3 as good according to the Nakai scale. Conclusion: The MED leads to less trauma and little influence on the stability of the posterior structure of the lumbar vertebrae. And the advantages of MED are removal of the annulus fibrosus,the calcified ligamentum flavum and osteophyte. It can be used for the treatment of all types of lumbar disc herniation except revision cases.