内镜下治疗腰椎软骨板破裂症  

Clinical application of microendoscopic discectomy via spinal posterior access in the treatment of broken intervertebral cartilage

作　　者：李玉伟[1] 严晓云[1] 王海蛟[1] 

机构地区：[1]河南省漯河市中心医院脊柱科,河南漯河462000

出　　处：《中国内镜杂志》2007年第12期1263-1265,1268,共4页China Journal of Endoscopy

摘　　要：目的探讨显微内镜下多椎板开窗治疗腰椎软骨板破裂症的有效性。方法12例腰椎软骨板破裂症患者在显微内镜下配合直式骨刀截骨减压以及L形骨刀切除椎体后缘骨性致压物,经椎板间隙切除黄韧带、部分椎板和关节突,扩大侧隐窝,切除椎体后缘骨性致压物,充分减压硬膜囊和神经根,并对临床疗效进行评定。结果除1例因硬膜囊撕裂较大改为传统手术外,完成二节段减压者2例、单节段者9例。每窗减压平均手术时间40min,每例平均出血160mL。术后2、3d下床,平均住院7d。经1.0～3.5年随访,均恢复正常工作。采用Macnab评定标准评定,优良率为90.9%。结论显微内镜下治疗腰椎软骨板破裂症,能够切除椎体后缘软骨板破裂等形成的骨性致压物,达到与开放手术同样减压的目的,并能维持腰椎稳定,术后效果优良。[Objective] To explore the clinical effects and application value of microendoscopic discectomy via spinal posterior access in the treatment of breaking intervertebral cartilage. [Method] Microendoscopic intervertebral space discectomy was performed in 12 patients with broken intervertebral cartilage. Bilateral nerve root decompression through free skin flap, two levels decompression through moving the tubular retractor in cranial or caudal direction were performed with the same small skin incision; A laminotomy and root canal decompression were done with the manual drill and straight osteotom specially made and excision of posterior hard bony edge of the vertebrae with ＂L＂ shaped osteotom. [Result] The 11 cases underwent the procedure designed preoperatively through the MED System except for one case undergoing standard open procedure, due to larger dural laceration. The results showed 90.9% had excellent or good outcomes with a minimum follow- up of 1 year. [Conclusion] The MED System with osteotom specially made may complete most of decompression of broken intervertebral cartilage of lumbosacral spine and its result is satisfied.

关 键 词：腰椎软骨板破裂症 显微内镜 手术 

分 类 号：R681.57[医药卫生—骨科学]