自动神经牵开器在显微内镜椎间盘切除术中的应用  

The application of automatic nerve retractor in micro-endoscopic discectomy

作　　者：银和平[1] 李树文[1] 白明[1] 杜志才[1] 曹振华[1] 武海军[1] 孟格栋[1] 

机构地区：[1]内蒙古医学院第二附属医院微创脊柱外科,呼和浩特010030

出　　处：《中华骨科杂志》2013年第1期39-43,共5页Chinese Journal of Orthopaedics

摘　　要：目的探讨自动神经牵开器在显微内镜椎间盘切除术（micro．endoscopic discectomy，MED）中的作用与临床效果。方法回顾性分析2009年8月至2010年12月，应用MED治疗腰椎间盘突出症350例患者资料，男196例，女154例；年龄17-68岁，平均42岁；L1-2 3例，L2-3 8例，L3-4 12例，L4-5 186例，kS1 141例。突出类型：中央型31例，旁侧型266例，极外型23例，破裂游离型30例。其中合并钙化37例，合并椎管狭窄66例。患者在MED中均应用自动神经牵开器。采用视觉模拟评分（vi．sual analogue scale，VAS）和Oswestry功能障碍指数（Oswestry disability index，ODI）评估患者术后疗效。结果350例患者均获得随访，随访时间6～16个月，平均9个月。VAS评分，术前（8．79±1．15）分，术后3个月（3．80±1．14）分，术后6个月（3．65±1．14）分。ODI，术前78％±1．71％，术后3个月28％±1．72％，术后6个月28％±1．88％。术后各个时间点VAS评分和ODI均较术前有明显改善，术后各时间点比较无明显差异。术后无一例发生脊髓及神经根损伤、硬膜外血肿形成。1例发生椎间隙感染，给予切吸、引流，卧床休息，消炎止痛等对症治疗3周后治愈。2例术后切口发生缝线反应导致切口延迟愈合，经拆线后清洁换药3--4周痊愈。1例术后切口发生感染，经清洁换药及对症治疗6周后痊愈。2例患者因长时间卧床缺少活动而致下肢静脉血栓形成，其中1例经物理疗法、药物及对症治疗后康复，另1例经介入放置滤网结合药物溶栓得以康复。结论在MED中配合使用自动神经牵开器可有效显露术区，保护周围神经不受损伤，减轻手术人员的工作量，有较好的临床应用价值。Objective To explore the function and clinical effect of automatic nerve retractor in mi- cro-endoscopic discectomy. Methods From August 2009 to December 2010, 350 patients with lumbar disc herniation were treated by micro-endoscopic discectomy, including 196 males and 154 females, aged from 17 to 68 years （average, 42 years）. Three cases were at L1-2, 8 at L2-3, 12 at L3-4, 186 at L4-5 and 141 at L5S1 The automatic nerve retractor was used in all micro-endoscopic discectomy. The visual analogue scale （VAS） and Oswestry disability index （ODI） were used to evaluate clinical outcomes. Results All patients were followed up for 6 to 16 months （average, 9 months）. The mean VAS score decreased from preoperative 8.79±1.15 to 3.80±1.14 3 months after operation and 3.65±1.14 6 months after operation. The mean ODI score decreased from preoperative 78%±1.71% to 28%±1.72% 3 months after operation and 28%±1.88% 6 months after operation. Postoperative VAS and ODI scores decreased significantly compared with those before operation. The VAS and ODI scores 6 months after operation were not significantly improved compared with those 3 months after operation. No spinal cord and nerve root injury and epidural hematoma formation occurred in all cases. Conclusion In micro-endoscopic discectomy, the automatic nerve retractor can help the operator obtain effective exposure, protect nerves from injury, alleviate workload of the operators, therefore it has a great clinical application value.

关 键 词：内窥镜检查 椎间盘移位 椎间盘切除术 

分 类 号：R687.3[医药卫生—骨科学]