经皮椎间盘镜腰椎间盘摘除术  

Percutaneous Discoscopic Lumbar Discectomy

作　　者：田世杰[1,2] 王进军[1,2] 刘德隆[1,2] 黄辉 杨煦[1,2] 苏庆军 

机构地区：[1]北京首都医科大学附属红十字朝阳医院骨科 [2]北京东城区骨伤医院骨科

出　　处：《中华骨科杂志》1997年第5期321-324,共4页Chinese Journal of Orthopaedics

摘　　要：本文报告１９９２年１月～１９９６年６月期间应用经皮椎间盘镜腰椎间盘摘除术（ＡＭＤ）治疗腰椎间盘突出症２６８例，３７７次手术。随诊１９１例，平均２．５年，优良率８２．２％。强调俯卧位手术。穿刺失败原因：椎间盘退变重，关节突肥大增生三角工作区被遮挡，髂骨发育高，置入套管（６．４ｍｍ）有异感。使用椎间盘镜清晰显示局部解剖，直视观察减压区并可调整套管减少神经根损伤机会。对３０具成人尸体腰神经根周围局部解剖观察及测量：Ｌ２、Ｌ３、Ｌ４神经根最佳进针角度为４４．４°±２．２１°，Ｌ５神经根是３５．４°±２．３１°。脱出型（后纵韧带未穿破）及中央型采用双侧穿刺手术，增加摘除大块退变间盘的机会，使减压充分，提高这类突出病例的疗效。本组脱出型双侧穿刺手术５４例，中央型双侧穿刺手术７８例，随诊优良率７６％。ＭＲＩ检查对脱出型病例有无后纵韧带破裂起关键作用。这对脱出型腰椎间盘突出症能否选择经皮穿刺治疗方法起决定因素。本组并发症少，仅在早期发生神经根一过性不全损伤２例，术后２个月恢复。与穿刺操作者未按旋转进针原则有关。percutaneous arthroscopic micrediscectomies in 268 patients were performed between 1992 and 1996. There were 191 cases availble for folow_up. 82.2% of the patients obtained excellent and good results with an average of 2.5 years follow_up. The authors emphasize that the operation should be performed in the prone position and the puncture failure may be due to serious regression of the disc, hypertrophy and hyperplasia of the articular process and high developed ilium. Discoscope can clearly reveal the local anatomic structure and protect the nerve root from injury under direct vision. Examination and measurement of 30 adult corpses showed that the optimal puncture angle was 44.4± 2.21 in L 2,L 3 and L 4, 35.4± 2.31 in L 5. Fitty_four prolaspsed (without rift of posterior longitudinal ligament) and 78 central typed herniation in this series were punctured from both sides and obtained an excellent and good rate of 76% . MRI is a valuable method to determine the intact of the posterior longitudinal ligament. Only two early cases had temporary partial injury to nerve root because misinserting, and all of them recoverd 2 months later.

关 键 词：腰椎 椎间盘突出 椎间盘关节镜 椎间盘摘除术 

分 类 号：R681.530.5[医药卫生—骨科学]