文档介绍：腰椎间盘镜手术治疗双节段椎间盘突出症的远期临床疗效随访
作者:洪有志,吴小涛,茅祖斌,王宸,陈辉,王运涛,谢凌寒,牛军涛
【摘要】目的:探讨采用后路腰椎间盘镜手术(MED)治疗双节段椎间盘突出症的技术特点及其远期疗效。方法:回顾分析东南大学附属中大医院2002~2004年54例双节段椎间盘突出症经MED治疗的临床资料。结果:对54例108个椎间盘进行手术,平均每台手术时间为72 min,平均术中量为55 ml,术后平均住院7 d。随访3~60个月,平均16个月,ab标准改良统计,手术优良率达93%。结论:MED治疗两节段椎间盘突出症安全有效。
【关键词】腰椎间盘突出症; 双节段; 腰椎间盘镜手术
[Abstract] Objective: To explore the experience and the longterm effect in treating the doublesegmental lumbar disc herniation by microendoscopy discectomy(MED) with posterior vertebral route approach. Methods: We retrospectively analysed the data of 54 cases of doublesegmental lumbar disc herniation treated with microendoscopy discectomy from 2002 to 2004 in the Zhongda Hospital of Southeast University. Result
s: Fiftyfour cases including 108 intervertebral spaces were treated by MED technique. The average operation time was 72 min , the average volume of bleeding was 55 ml, and the average hospital stay after operation was 7d .All cases were followed up for 3 to 60 months with an average of 16 months. A total of 93% patients gained excellent and good results. Conclusion: Microendoscopy discectomy with posterior vertebral route approach in treating doublesegmental lumbar disc herniation is safe and effective.
[Key words] lumbar disc herniation; doublesegment; microendoscopy discectomy
Foley和Smit研制出经腰椎后正中入路的腰椎间盘镜手术(microendoscopy discectomy,MED)系统,应用临床10多年,这套系统符合微创理念、安全性高、应用方便,取得较好疗效。因椎间盘镜“学习曲线”较长,两节段椎间盘突出又存在定位困难,创伤较单一节段大、手术操作难度较大,故椎间盘镜下治疗两节段椎间盘突出症的安全性及有效性常遭疑虑。作者对我院2002~2004年利用MED治疗的两节段腰椎间盘突出症进行远期疗效随访,结果疗效肯定。
1 资料与方法
病例资料
随访患者54例,其中男性32例,女性22例,年龄21~67岁,平均44岁。病史4个月到6年不等,均为双节段突出,其中L4~5+L5S1 43例,L3~4+L4~5 10例,L2~3+L3~4 1例,合并椎管狭窄3例。患者术前均行CT及磁共振检查,临床症状典型,多节段椎间盘突出诊断明确,且均接受过6周以上保守治疗,无明显疗效。见图1~3。
图1 1例患者腰椎正侧位图2 1例患者腰椎CT平扫示:L4~5L5S1椎间盘突出(术前)
左图为矢状位MR平扫示L4~5 L5S1椎间盘突出;右上图为轴状位MR示L4~5椎间盘突出压迫左侧神经根;右下图为轴状位MR示L5S1椎间盘突出
图3 1例患者腰椎MR平扫(术前) 手术器械
枢法模公司提供的MED系统:显示监视系统,由镜头、显示器、冷光源、摄像机和录像机组成; cm内径的圆形手术通道;自由臂;专用配套手术器械,包括各种型号枪钳、髓核钳、刮匙、剥离子、带吸引器的神经根拉钩、吸