可动式椎间盘镜技术治疗腰椎间盘突出症和椎管狭窄症  

Mobile microendoscopic discectomy technique for lumbar disc herniation and canal stenosis

作　　者：徐宝山[1] Destandau Jean 夏群[1] 吉宁[1] 胡永成[1] 张继东[1] 苗军[1] 周静[1] 

机构地区：[1]天津医院脊柱外科,300211 [2]法国波尔多Bagatelle医院神经外科

出　　处：《中华骨科杂志》2009年第2期112-116,共5页Chinese Journal of Orthopaedics

摘　　要：目的探讨可动式椎间盘镜技术治疗腰椎间盘突出症和腰椎管狭窄症的疗效。方法应用可动式椎间盘镜技术治疗腰椎间盘突出症130例、退变性椎管狭窄症60例、椎间盘突出合并椎管狭窄122例。26例有同一节段手术史。法国Bagatelle医院212例，均为单处开窗减压，双侧狭窄者潜行减压至对侧；天津医院100例，单处开窗82例、两处开窗14例、三处开窗3例、四处开窗1例，其中g例伴失稳者行镜下B-Twin椎体间融合术。根据Macnab评分标准评定疗效。结果术后随访1-24个月，平均12个月。法国Bagatelle医院单侧手术时间平均35min，双侧减压平均45min；术中出血量平均35ml；术中硬膜囊撕裂1例；术后当天下床活动，平均住院1．2d。疗效优191例，良15例，可6例；200例于术后3周内恢复原工作或生活。天津医院单处手术平均50min；术中出血量平均100ml；术中转开放手术2例，定位错误4例，神经根部分损伤2例，硬膜囊撕裂4例，切口浅表感染2例；术后1-3d下床活动，平均住院5d。疗效优80例，良15例，可5例。71例术后3周内恢复原工作或生活。结论可动式椎间盘镜手术器械可随意倾斜或摆动，使椎间盘切除手术操作更方便，减压彻底，效果优良。Objective To develope a mobile microendoscopic discectomy （MED） technique, and evaluate the clinical results of this technique for the treatment of lumbar disc herniation and canal stenosis. Methods 312 patients were treated with this technique in two hospitals for lumbar disc herniation and/or canal stenosis, these included disc herniation in 130 cases, disc herniation and lateral stenosis in 122 cases, degenerative canal stenosis in 60 cases. 26 of them had the history of surgical intervention at the same level. 212 patients were operated in Bagatelle hospital in France, followed a single level decompression. 100 patients were operated in Tianjin hospital in China, including 1, 2, 3 and 4 fenestrations in 82, 14, 3 and 1 cases, respectively, and interbody fusion was performed with B-Twin in 4 cases with instability. The patients were followed from 1 to 24 months and the results were evaluated with Macnab scale. Results In Bagatelle hospital, the mean operative time was 35 and 45 rain for unilateral and bilateral decompression, respectively, with a mean blood loss of 35 ml, and only one complication of dural theca tear was encountered. The patients were discharged within 1-2 d after operation without limitation of activity. The results were excellent in 191 cases, good in 15 cases and fair in 6 cases, and 200 patients recovered their work or normal activities in 3 weeks. In Tianjin hospital, the operative time was 50 rain with a mean blood loss of 100 ml. Complications included conversion to open surgery in 2 cases, location errors in 4 cases, which were recognized intraoperatively and immediately corrected, partial nerve root lesions in 2 cases, dural theca tears in 4 cases, and su- perficial incision infections in 2 case. The mean hospital stay was 5 d after operation. The results were excel- lent in 80 cases, good in 15 cases and fair in 5 cases, and 71 patients recovered their work or normal activities in 3 weeks. Conclusion Compared to METRx system, the MED can be performed more easily with thorough dec

关 键 词：腰椎 椎间盘移位 椎管狭窄 内窥镜检查 

分 类 号：R686[医药卫生—骨科学]