脊柱显微内窥镜治疗腰椎间盘突出症的手术适应证与术式选择探讨  

Approach the Surgical Indication and Choice of Operative Procedures of Microendoscopic Disectomy for the Treatment of Lumbal Intervertebral Disc Herniation

作　　者：张朝跃[1] 彭耀庆[1] 吴松[1] 江皓[1] 臧晓芳[1] 杨檑[1] 苗杰[1] 詹新立[1] 

机构地区：[1]中南大学湘雅三医院骨科,湖南长沙410013

出　　处：《中国医师杂志》2002年第1期14-16,共3页Journal of Chinese Physician

摘　　要：目的　探讨脊柱显微内窥镜治疗腰椎间盘突出症 (LumbarIntervertebralDiscHerniation ,LIDH)的手术适应证与术式选择。方法　应用脊柱显微内窥镜手术系统 (MicroendoscopicDiscectomy ,MED)治疗LIDH患者10 7例 ,其中单纯MED手术 (MED组 ) 93例 ,辅助MED手术 (辅助组 ) 14例 ;根据患病年龄 (青壮年组 <5 0岁 ,中老年组≥ 5 0岁 )、椎间盘突出类型 (中央型 ,旁侧型 ,极外侧型 )以及是否伴有椎管内合并症对MED组的 93例患者作疗效分组分析。结果 10 7例均获随访 ,平均随访 8个月 ,根据Macnnab标准评定疗效 :MED组 :优 73例 ,良 12例 ,可 8例 ,优良率 91 40 % ;辅助组 :优 10例 ,良 3例 ,可 1例 ,优良率 92 .86 %。两组疗效无明显差异 (P >0 0 5 )。青壮年组的MED疗效明显高于中老年组 (P <0 0 0 1) ;中央型突出与旁侧型突出的MED疗效无明显差异 (P >0 0 5 ) ;椎管内合并症对MED手术疗效有明显影响 (P <0 0 1)。结论　适应症的掌握与术式选择是影响MED手术疗效的重要因素 ;LIDH的CT病理学分型可作为MED手术的一个重要适应症 ;中央型突出不应列为MED手术禁忌症 ;Objective To investigate the surgical indication and choice of operative procedures of microendoscopic discectomy (MED) for the treatment of lumbar intervertebral disc herniation(LIDH).Methods 107 cases of LIDH were treated by MED .Among them , 93 cases received MED only,and 14 cases auxiliary MED were done.According to the ages , the types of LIDH and whether the patients had the intravertebral complication , we analyzed the curative effect of 93 MED cases in different groups.Results Based on Macnnab criterion , 107 cases were followed up for 8 months, 73 cases were evaluated as excellent , 12 cases good and 8 cases fair.In the auxiliary group , 10 excellent , 3 good and 1 fair.There was no significant difference between the two groups (p>0 05 ) . But the results in the adolescent adult group undergone MED were better than the aged group (p<0 001).There was no significant difference between central type LIDH and lateral type LIDH (p>0 05 ).Intravertebral complications had a significant effect on operative results (p<0 01).Conclusions The surgical indication and choice of operative procedures are the main causes of the operative result of MED . The CT phathological classification of LIDH can be regarded as an important indication of MED . The central type LIDH should not be listed as contraindication of MED .The auxiliary MED is a safe and effective way to cure the patients with severe vertebral canal stenosis .

关 键 词：腰椎间盘突出症 内窥镜 显微手术 适应症 治疗 

分 类 号：R681.53[医药卫生—骨科学]