显微椎间盘镜髓核摘除术治疗腰椎间盘突出症  

Operative Treatment on Lumbar Disc Herniation With Microendoseoopic Discectomy

作　　者：许声联[1] 杨柏林[1] 邹重文[1] 邓迎生[1] 

机构地区：[1]解放军第187中心医院骨科,海口571159

出　　处：《海南医学》2002年第11期8-10,共3页Hainan Medical Journal

摘　　要：目的　探讨采用显微椎间盘镜系统行腰椎髓核摘除治疗腰椎间盘突出症的效果。　方法　所有病例均采用第二代MED技术行髓核摘除术。选择 2 1例术前有典型的临床症状及体征 ,结合X光照片CT或MRI检查证实为腰椎间突出症的病例 ,平均年龄 3 1岁 ,平均病史 2 5 6天 ,进行了 2 5个核间隙的髓核摘除。结果　所有病例每间隙手术时间 60～ 180分钟 ,术中平均出血 5 0ml摘除髓核重量为 2 .0～ 5 .0g ,平均 3 .5g。术后第二天可带腰围下地行走 ,3周恢复正常生活与工作 ,术后随访 2～ 6个月 ,疗效按Macnnab标准 ,优 2 0例 ,良 3例 ,可 2例 ,优良率 92 % ,无神经根损伤 ,硬脊膜破裂及椎间隙感染等并发症。结论　MED是将传统的髓核摘除术内窥镜化和微创化 ,该方法创伤小 ,恢复快 ,在可视下手术准确性高 ,不易损伤脊髓或神经 ,是目前治疗腰椎间盘突出症较为理想的一种方法 ,但对伴有严重的骨质增生及椎管狭窄者应慎重选择。Objective: To explore the clinical results of operation on lumbar disc herniation(LDH) with microendoscropic discectomy(MED). Methods: The MED technique (No.2) was used to excise the nucleus pulposus in 21 cases (including 25 herniated discs) who had been proved to be LDH by their typical symptom and sign,Ray X, CT and MRI,whose average age was 31 years and average disease history was 256 days. Results: In the cases, the operational time of each disc was 60～180min utes and the average haemoptysis was 50ml while the average removed nucleus pulposus weight was 3.5g(2.0～5.0). The patients could walk with waists bands in the second day after operation,resumed their daily and went back to work in 3 weeds. Followed up 2～6months,according to Macnnab's standard,all cases had no complication such as injuring the nerve root,dural laceration and the disc inflection,in which 20 cases were excellent,3 were good and 2 were fair,and the rates of excellent and good results were 92%. Conclusion: The MED system is the microendoscopic and minimally invasive one of the traditional discectomy, which has so many advantagey such as mini trauma,quick resumption,precise operation under direct vision that it is not easy to injury the spinal code or nerves. The MED is a kind of ideal treatment on LDH,but it should be careful to be used in the LDH cases concomitant with serve osteophyte and spinal canal stenosis.

关 键 词：显微椎间盘镜 髓核摘除术 腰椎间盘突出症 手术方法 手术适应证 

分 类 号：R681.530.5[医药卫生—骨科学]