显微内窥镜下椎间盘切除术的适应证选择与疗效  

Operative indication and therapeutic efficancy of lumbar disc herniation with microendoscopic discectomy

作　　者：戴守达[1] 董小雄[1] 张耘[1] 王永宏[1] 张洪师[1] 周正顺[1] 

机构地区：[1]解放军第86医院骨科,安徽省当涂市243100

出　　处：《中国脊柱脊髓杂志》2006年第4期252-254,共3页Chinese Journal of Spine and Spinal Cord

摘　　要：目的:探讨显微内窥镜下椎间盘切除术(MED)治疗腰椎间盘突出症的手术适应证及其临床效果。方法:对357例具有手术指征的腰椎间盘突出症患者,选择其临床表现为单侧腰腿痛、单一神经根受累且腿痛症状大于腰痛、影像学显示单间隙后侧方突出或脱出且无脊椎滑脱和腰椎失稳表现、临床表现与影像学检查结果一致等条件作为开展MED的适应证,共开展MED166例,占同期腰椎间盘突出症手术的46.5%。结果:平均随访22.6个月,无一例出现硬脊膜及神经根损伤、椎间隙感染等严重并发症,按照Nakai评价标准,优良率为98.7%。结论:MED作为治疗腰椎间盘突出症的一种手段,尚不能完全取代常规开放手术,在掌握开放手术技术的前提下,严格选择手术适应证、灵活运用手术技巧等可提高手术疗效并降低并发症。Objective： To explore and discuss the operative indication and clinical results of lumbar disc herniation （LDH） by microendoscopic discectomy （MED）. Method： 357 cases of LDH with surgical indication were documented, in which 166 cases underwent MED procedure. MED was recommended when the sciatica was more severe than back pain, imaging studies showed concordance with clinical finding, no spondylolysis or lumbar instability. Result： There was none of the severe operative complication, such as dural tear, nerve root lesion, interspace infection, ere. The average follow-up was 22.6 months （12～28 months）. According to Nakai sdandard, excellent and good rate was 98.7%. Conclusion： To be a minimally invasive procedure in spinal surgery, MED can＇t fully replace the convetional discectomy. However, under the condition of mastering the convetional discectomy skill, strictly controlled indication and skilled surgical performance are the key to improve outcome and to minimize the complication.

关 键 词：腰椎间盘突出症 显微内窥镜 适应证 

分 类 号：R681.5[医药卫生—骨科学]