MED治疗老年腰椎管狭窄症44例体会

Microendoscopic discectomy in the treatment of lumbar spinal stenosis in 44 elderly patients

目的 探讨显微内镜后路椎间盘手术系统 (MED)治疗老年腰椎管狭窄症的价值。 方法 根据含定位物的腰椎正、侧位X线片定位 ,在局部麻醉或浅硬外麻醉下建立MED系统 ,用自制微型骨刀凿去部分椎板、增生内聚的关节突 ,彻底解除硬脊膜及神经根周围的压迫。 结果 手术时间 2 5～ 180min。术中出血量 5 0～ 30 0ml。 1例因硬膜及神经根与周围组织广泛粘连中转开放手术。 4 4例均获随访 ,时间 3～ 4 0个月 ,平均 15个月。按照Nakai评价标准 :优 30例 ,良 8例 ,差 6例 ,优良率 86 4 % (38/ 4 4 )。并发症 :椎间隙感染 1例 ,出现健肢症状 2例。 结论 MED创伤小、出血少、恢复快 ,在神经充分减压的前提下 ,能尽可能保持脊柱的稳定性 ,是治疗老年性腰椎管狭窄症有效方法之一。

Objective To investigate the value of posterior approach microendoscopic discectomy (MED) in the treatment of lumbar spinal stenosis. Methods In the light of preoperative localization by anterioposterior and lateral X-ray examinations of labeled lumbar vertebrae, the MED system was established under local anesthesia or epidural blockage. Part of lamina and hyperplastic and cohesive articular processes were removed by using a self-made osteotome to fully decompress the dura mater and nerve roots. Results The operation time ranged 25～180 min, with an intraoperative blood loss of 50～300 ml. A conversion to open surgery was required in 1 case because of widespread adhesions of the dura mater and nerve roots. All the 44 patients were followed for 3～40 months (mean, 15 months). According to Nakai criteria, 30 patients had an 'excellent' result, 8 patients had a 'good' result and 6 were classified as 'poor', the rate of 'good' or 'excellent' results being 86.4% (38/44). Postoperative infection of intervertebral space and symptoms on healthy limbs were observed in 1 case and 2 cases, respectively. Conclusions MED has the advantages of minimal invasion, little blood loss and rapid recovery. It can offer both full decompression to nerves and the stability of spine to the greatest possible advantage, being an effective means in the treatment of lumbar spinal stenosis in elderly patients.