腰椎间盘镜治疗腰椎间盘突出症术后并发症分析及其防治对策  

Analyses of the Complications of Lumbar Disc Surgery with Microendoscopic Discectomy System

作　　者：魏国文[1] 谭小云[2] 沈锋[1] 邱晓洪[1] 

机构地区：[1]南昌市第一医院骨科,江西南昌330008 [2]中山大学附属第三医院骨科,广东广州510630

出　　处：《实用临床医学（江西）》2005年第10期67-70,共4页Practical Clinical Medicine

摘　　要：目的:探讨后路腰椎间盘镜(Microendoscopic Discectomy,MED)治疗腰椎间盘突出症术后发生围手术期并发症的原因及其防治对策.方法:回顾分析我院2001年5月～2005年4月期间所有行MED手术的椎间盘突出症患者共412例,对其所发生的围手术期并发症进行归类统计并分析原因和对策.结果:各类围手术期并发症发生的总例数为26例,发生率为6.31%.其中椎管内血管破裂7例(其中术后发生迟发性血肿引起马尾神经压迫1例);单纯硬脊膜撕裂6例(其中2例术后发生脑脊液漏);硬脊膜破裂合并马尾神经束损伤2例;神经根损伤4例、(铅夹伤3例,牵拉伤1例);突出椎间盘摘除和/或侧隐窝扩展不足3例;术后椎间隙感染2例;术中定位错误2例.按Nakai分级:优206例,良184例,可14例,差8例,优良率94.66%.结论:术者经验、技术水平、操作技巧以及手术适应症的选择与MED围手术期并发症有关,合理选择适应症、熟练掌握腰椎手术技巧及器械操作技术、术中充分显露仔细操作、C形臂X线机定位及彻底止血是减少并发症的关键.Objective： To investigate the causes and the prevention of perioperative complications after MicroEndoscopic Discectomy System （MED）. Methods：Four hundred and twelve cases were treated by microendoscopic discectomy system from May 2001 to April 2005 in our hospital. Results：In all 26 cases with complication, lumbar epidural space vascular bleeding happened in 7 cases,dural rupture in 6, dural rupture accompanied with nerve injury in 2,nerve root damage in 4, operative omission in 3, postoperative infection in 2, and wrong localization in 2, respectively. Conclusion： Perioperative complications of MED are related to various factors, but surgens＇clinical experiences of MED manipulation and the right indication are the most important factors for prevention of patients from the complications.

关 键 词：椎间盘突出症 椎间盘镜 并发症 预防 

分 类 号：R681.53[医药卫生—骨科学]