摘要
目的研究显微内窥镜椎间盘切除术(microendoscopicdiscectomy,MED)治疗腰椎间盘突出症的特点及易出现的情况和并发症,以提高手术疗效。方法通道管经棘突旁小切口进入,在显微内窥镜下半环切除椎板下部,外侧黄韧带、关节突内侧。保留硬膜束后方黄韧带,用棉片、保护器保护神经,环切突出的纤维环和髓核组织,扩大根管。增添自制的切刀等器械。本组共248例,其中90例经术后随访24～32个月,平均27.2个月。结果术后平均1.9d下床行走,2.4周恢复日常生活,4.3周恢复工作,术后改善率为83.1%。初期手术可能出现:(1)定位错误;(2)进入椎管困难;(3)止血困难;(4)损伤硬膜,加重神经根水肿;(5)损伤关节突关节。结论MED有直接切除髓核、钙化后纵韧带、增生骨,创伤小,照明好等特点,但它的通道管末端不易与椎板表面固定。MED是发展中的技术,需改进器械和内窥镜,增加特殊器械,提高手术的安全性、简易性。
Objective To study the technical details, clinical results and complication of microendoscopic discectomy (MED) for the treatment of lumbar disc herniation. Methods Ninety cases of lumbar disc herniation were operated upon with MED, and followed up for 24-32 months. Under direct endoscopic manipulation, semi circular excision of the inferior part of lamina, removal of the lateral part of the ligamentum flavum and the medial part of the facet were performed. The annulus fibrosus was circularly excised and the nucleus pulposus was removed. Results After operation, the patients could walk in 1.9 days, resumed their daily activities in (2.4±1.9) weeks and went back to work in (4.3±3.8) weeks. The rate of improvement was 83.1%. Several technical problems could happen in the beginning of using MED, including wrong identification of the vertebral level, difficulty to enter into the spinal canal and to control the bleeding, as well as injury of nerve root, dura mater and facet joint. Conclusion The advantages of MED are removal of the annulus fibrosus, the calcified ligamentum flavum and osteophyte under direct vision. However, sometimes it is difficult to fix the tip of microendoscopic tube on the surface of the lamina. Improvement is needed for the instrument design in order to increase the safety and easier manipulation.
出处
《中华骨科杂志》
CAS
CSCD
北大核心
2002年第1期17-19,共3页
Chinese Journal of Orthopaedics
