脊柱内窥镜治疗腰椎间盘突出症150例分析  

AN ANALYSIS OF 150 CASES WITH LDH TREATED WITH MED

作　　者：彭耀庆[1] 张朝跃[1] 李小如[1] 杨辉芳[1] 詹瑞森[1] 

机构地区：[1]中南大学湘雅三医院骨科,长沙410013

出　　处：《中国内镜杂志》2001年第6期28-30,共3页China Journal of Endoscopy

摘　　要：目的 :探讨脊柱内窥镜治疗LDH的临床价值及其疗效影响因素。方法 :回顾分析 15 0例经脊柱内窥镜(MED)手术治疗的LDH患者 ,根据患病年龄与椎管内合并症情况分别分为青壮年组、中年组、老年组三组与A ,B ,C三组 ,按临床特点又将年龄超过 5 0岁的LDH分为Ⅰ、Ⅱ两型 ,分别计算其疗效优良率并做 χ2 检验。结果 :15 0例均获随访 ,平均随访 8.5月 ,按Macnnab标准评定疗效 ,优 12 2例 ,良 15例 ,可 13例 ,优良率为91.33% ;青壮年组的手术优良率明显高于中老年组 (P <0 .0 1) ,Ⅰ型患者的手术优良率明显高于Ⅱ型 (P <0 .0 5 ) ;椎管内合并症对MED手术疗效有明显影响 (C组优于A组 ,A组优于B组 ,P <0 .0 5～ 0 .0 0 1) ;中央型突出与旁侧型突出的疗效无明显差异 (P >0 .0 5 )。结论 :患病年龄与椎管内合并症是影响MED手术疗效的重要因素。Ⅱ型中老年LDH以及狭窄型LDH均应列为MED手术的相对禁忌证 ,而中央型突出则不应列为MED手术禁忌证 ;MED手术是一种辨认清晰、定位精确、疗效肯定的LDH“直视下微开窗”术式 ,由于设备昂贵 ,技术要求较高 ,只适宜做临床有限推广。Objective:To explore the clinical meaning,operative indication and treatment effect of MED.Methods:One hundred and fifty cases with LDH were reviewed retrospectively.They were divided into adolescent-adult group,adult group,old group and A group,B group,C group according to their ages and intro-spinal complications respectively.Cases over fifty years old were divided into I type and Ⅱ type .The treatment results were evaluated.Results:150 cases were followed-up(mean 8.5 months).Based on Macnnab criterion,122 cases were excellent,15 good,6 fair;the excellent results were seen in adolescent-adult group and Ⅰtype;intro-spinal complications made a significant effect on operative results(C better than A,A better than B);There was no significant difference between central type LDH and lateral type LDH( P <0.05).Conclusions:①The ages and intro-spinal complications were main causes of the operative result of MED.Ⅱ type LDH and narrow type LDH should be regarded ass relative counterindication of MED.②MED operation is a method of clear view,precise orientation and excellent effect;but it needs more expense and high technique,therefore,limited popularization can only be made.

关 键 词：内窥镜 腰椎间盘突出症 微侵袭 分型治疗 

分 类 号：R681.530.5[医药卫生—骨科学]