MED治疗腰椎间盘突出症时对神经根变异的探查

目的：观察显微内窥镜下椎间盘切除术（microendoscopic discectomy，MED）治疗腰椎间盘突出症时神经根变异情况，防止出现术中神经根损伤。方法：回顾分析自1999年10月至2003年12月应用MED治疗的腰椎间盘突出症患者724例，其中男452例，女272例。对术中发现存在腰骶神经根变异患者的临床特点及术中所见进行统计分析。结果：724例腰椎间盘突出症患者有37例神经根变异，发生率为5.1％。与术前的临床表现吻合，全部神经根变异患者均在MED下完成手术，无一例出现神经根损伤。结论：仔细探查及分离突出髓核周围神经根发出情况．确定有无神经根变异是防止MED治疗腰椎间盘突出症时发生神经根损伤的重要环节之一。

Management of lumbosacral nerve root anomalies under microendoscopic discectomy

Objective:To observe the lumbosacral nerve root anomalies in the patients with lumbar intervertebral disc protrusion undergoing microendoscopic discectomy(MED),and the prevention of nerve root injury.Method:A total of 724 patients(452 male and 272 female)with lumbar intervertebral disc protrusion were treated with MED from October 1999 to December 2003.The clinical presentation and surgical procedure of each patient complicated with lumbosacral nerve root anomalies were analyzed statistically.Result:37 of 724 patients(rate 5.1%)were complicated with lumbosacral nerve root anomalies.All the 37 patients were operated under MED and the clinical presentation of these 37 patients were concident with their intraoperational findings.No nerve root injury was noted.Conclusion:It is very important to carefully explore the nerve root around the protruded intervertebral disc and determine the presence of nerve root anomalies with the purpose to prevent nerve root injury during MED.