可调节斜位在显微内窥镜腰椎间盘切除术中的应用  

Application of adjustable oblique position for microendoscopic discectomy

作　　者：王欢[1] 刘学勇[1] 李雷[1] 陈卫民[2] 王海义[1] 

机构地区：[1]中国医科大学附属第二医院第二骨科 [2]中国医科大学附属第二医院麻醉科

出　　处：《中华外科杂志》2005年第16期1080-1083,共4页Chinese Journal of Surgery

摘　　要：目的探讨可调节斜位在显微内窥镜腰椎间盘切除术(MED)中的应用及其优点。方法2000年8月至2002年8月对128例腰椎间盘突出症患者行MED术,分为可调节斜位组81例,俯卧位组47例。对比分析手术时间、出血量、患者耐受情况等;测量并对比分析其他29例腰椎全身麻醉手术患者的仰卧、侧卧及俯卧位的气道阻力。结果俯卧位和斜位组的术中出血量、进入椎管需用时间及患者对体位的耐受情况相比有显著差异。俯卧组手术时间超过50min,75%患者有肋弓部压迫难以耐受或疼痛,38%有恶心头晕。所有患者的肋弓部垫起处均有红斑和压痕。斜位组患者3例肩部疼痛,1例术后对侧下肢腓总神经瘫4d后恢复。骨突无压痕,双下肢静脉输液通畅。测量全身麻醉下腰椎手术患者的俯卧位气道阻力比仰卧及侧卧位时高(P<0.05)。结论可调节斜位应用于MED术可行,且有以下优点:(1)不限制胸廓运动,腹腔压力减少,术中出血少;(2)腰椎充分后凸椎板间隙最大,需切除椎板少,不易损伤小关节;(3)增加椎体后缘椎间隙,容易切取髓核,显露神经根和根管清楚;(4)患者较舒适,术中可调整腰椎、下肢位置;(5)操作面与显示器方向相同,易于手眼配合;(6)医生可坐位手术。Objective To compare the adjustable oblique position with prone position in microendoscopic discectomy （MED） and to evaluate its advantages. Methods One hundred and twenty-eight patients who underwent MED during August 2000 and August 2002 were studied. Forty-seven cases were positioned prone, 81 cases were positioned with adjustable oblique position. Operating time, blood loss and patient endurance were recorded and compared. The airway resistance of 29 lumbar disorder patients was measured when they were positioned supine, lateral and prone respectively after general anesthesia. Results There was statistically significant difference between 2 groups in operating time, blood loss and endurance. In prone position group, when operating time lasted for more than 50 rain, 75% patients felt hurt on the skin of rib arch,and 38% patients presented dizzy and nausea. And all the patients had erythema on the rib arch. In the adjustable oblique position group, 3 cases had shoulder pain after operation,and 1 case had 4 days＇ common poroneal nerve paralysis. The airway resistance of patients with prone position was significantly higher than those with supine and lateral positioned patients. （P 〈 0. 05）. Conclusion The adjustable oblique position in MED had the following advantages ： （ 1 ） Do not limit the movement of chest and help reduce intra-abdominal pressure and epidural bleeding; （2） Give the lumbar spine the largest degree of flexion and the largest interlaminar space, which prevents injury of facet joint; （3） Increase posterior intervertebral space and make disectomy easier and exposure of nerve root and nerve root canal clearer; （4） The patients feel comfortable and can adjust the position of lumbar spine and lower extremity; （5） The monitor has the same direction with doctor, and it is easy for the doctor to operate; （6） Doctor can sit during operation.

关 键 词：椎间盘切除术 体位 腰椎间盘突出症 显微内窥镜腰椎间盘切除术 术中出血量 可调节 斜位 手术患者 手术时间 下肢静脉输液 

分 类 号：R687.3[医药卫生—骨科学]