脊髓造影在显微内镜腰椎间盘髓核摘除术中的指导意义  

Use of myelography in microendoscopic discectomy

作　　者：黄强[1] 杨安礼[1] 

机构地区：[1]上海市杨浦区中心医院骨科,上海200090

出　　处：《中国微创外科杂志》2005年第12期1017-1019,共3页Chinese Journal of Minimally Invasive Surgery

摘　　要：目的探讨脊髓造影在显微内镜腰椎间盘髓核摘除术(microendoscopic discectomy,MED)中手术方法选择的意义.方法经CT/MRI提示为腰椎间盘突出症196例术前行脊髓造影检查且椎管通畅者,根据患者症状、体征及脊髓造影检查结果采用3种不同手术方法.①脊髓造影显示在椎间隙水平有侧方压迹,伴有神经根鞘袖偏移者采用椎间盘镜下单纯椎间盘髓核摘除105例.②脊髓造影显示伴神经根鞘袖受压者采用椎间盘镜下相应部位减压和突出髓核摘除70例.③脊髓造影显示伴神经根鞘袖呈半球形压迫、类'7'字形者采用半椎板切除和突出髓核摘除21例.结果手术时间30～90 min,平均50 min.术中出血量30～120 ml,平均50 ml.无术中并发症.中转开放手术21例,其中椎管部分狭窄16例,椎板增厚5例.196例随访3～58个月,平均34个月,按照日本骨科协会腰背痛手术评分标准,MED术后(25.86±2.96)分较术前(13.21±4.96)分明显提高(t=38.24,P=0.000).按照综合Macnab及Watts标准,优123例,良41例,中11例;优良率为93.7%(164/175).结论脊髓造影对腰椎间盘突出症患者选择采用椎间盘镜下腰椎间盘髓核摘除术有重要参考价值.Objective To investigate the significance of myelography for selecting operation methods in microendoscopic discectomy （MED）. Methods A total of 196 patients with lumbar disc herniation diagnosed by CT/MRI received a myelography before MED. According to their clinical manifestations, signs, and outcomes of myelography, the patients were given three different operation methods. （1）Simple diseeetomy was performed in 105 patients with patent spinal canal, lateral impression at intervertebral level, and shift of the nerve root sleeve; （2）Discectomy with spinal decompression was performed in 70 patients with patent spinal canal and compression of the nerve root sleeve; （3）Discectomy with semilaminectomy was performed in 21 patients with patent spinal canal, semispherical compression of the nerve root sleeve, and 7 - shaped nerve root. Results The operation time was 30 - 90 min （ mean, 50 min） and the intraoperative blood loss was 30 - 120 ml （ mean, 50 ml）. No intraoperative complications occurred. Conversions to open surgery were required in 21 patients, including partial spinal stenosis in 16 patients and thickened vertebral plate in 5 patients. Follow - ups were carried out in 196 patients for 3 - 58 months （ mean, 34 months）. According to the Japanese Orthopedic Association （JOA） scoring system, the final scores significantly increased postoperatively （25.86 ± 2.96 ） than preoperatively （ 13.21 ± 4.96 ） （ t = 38.24, P = 0.00）. According to the Macnab and Watts standard, the rate of excellent or good results was 93.7% （ 164/175 ）. Conclusions Myelography has an important reference value for selecting operation methods of microendoscopic discectomy in patients with lumbar disc herniation.

关 键 词：腰椎间盘突出症 脊髓造影 椎间盘镜髓核摘除术 

分 类 号：R687.3[医药卫生—骨科学]