腰椎间盘突出症髓核摘除术后远期疗效报告

目的：探讨腰椎间盘突出症髓核摘除术的远期疗效。方法：回顾性分析腰椎间盘突出症髓核摘除10年以上的病例，运用日本矫形外科协会(JOA)评分系统进行评价，并摄X线片与术前对比。结果：48例病人术前JOA评分平均为5．7分，最后一次随访检查时平均为12．6分，平均恢复率为74％，76％的病人残留下腰痛，12．5％的病人有严重下腰痛。术后再突出3例，其发病年龄均在40岁以下。结论：髓核摘除术治疗腰椎间盘突出症的远期疗效确切，但残留下腰痛仍是一个重要问题。     

腰椎间盘突出症335例临床分析

腰椎间盘突出症是下腰痛和坐骨神经痛常见的原因之一，多见于青壮年，非手术治疗是本病的首选疗法。我们对住院的335例腰椎间盘突出症患者进行了非手术治疗和临床观察，现报告如下。1临床资料1．1一般资料本文335例患者中．男213例，女122例．单纯LIDH者284例（84．78％），合并腰椎管狭窄者51例（1．22％）；年龄最小24岁，最大71岁．平均45．1岁，病程最短0．5月，最长8年，平均10．5月；有明确外伤史者观5例（61．19％），从事体力工作152例（45．37％）。主要症状为下腰痛和坐骨神经痛．合并有间歇性跛行者45例（13．43％）．主要体征…     

腰椎终板Modic改变与腰椎间盘突出的相关性研究

[目的]探讨腰椎终板Modic改变与腰椎间盘突出的相关性及其意义.[方法]对628例患者(年龄14～85岁,平均50岁;男326例,女302例)腰椎MRI上L3、4～L5S1节段的Modic改变和腰椎间盘突出程度进行评估,统计两者的相关性.将单节段中、重度腰椎间盘突出者分为A组(仅该节段有Modic改变)和B组(任一节段均无Modic改变).统计两组下腰痛的发生率并采用疼痛视觉模拟评分(visual analogue scale,VAS)和Oswestry功能障碍指数评分(oswestry disability index,ODI)来评估腰痛程度.[结果]在1844个腰椎间盘中,椎间盘无突出组、轻度突出组、中度突出组和重度突出组Modic改变的发生率分别为6.83％、23.66％、42.72％和50.79％,差异有统计学意义(P＜0.01),Spearman相关检验表明Modic改变和腰椎间盘突出程度呈正相关(r=0.344,P＜0.01).A、B组下腰痛的发生率分别为59.32％和37.97％,差异有统计学意义(P＜0.01),但腰痛VAS评分和ODI评分差异无统计学意义(P＞0.05).[结论]腰椎终板Modic改变的发生与腰椎间盘突出程度呈正相关,当腰椎间盘突出合并Modic 改变特别是Ⅰ型改变时,下腰痛的发生率增加.     

ModicⅡ型改变对单纯髓核摘除术疗效的影响

[摘要]目的：探讨腰椎终板Modic11型改变对腰痛合并单侧下肢痛的腰椎间盘突出症患者手术疗效的影响。方法：选取2007年1月～2009年1月收治的下腰痛合并单侧下肢放射痛的腰椎间盘突出症患者共65例,其中有ModicⅡ型改变30例（A组）,     

腰椎间盘突出症再手术的相关因素及再手术方式分析

[目的]分析与腰椎间盘突出症再手术有关的部分因素，及对3种不同的再手术方法进行分析讨论。[方法]分析长征医院骨科1999年1月～2004年12月，5a间1327例腰椎间盘突出症手术中102例再手术的原因，并对性别、年龄、再手术间隔时间等相关因素进行比较、统计学分析，结合分析的结果对3种再手术方式即髓核摘除术、扩大减压术和减压植骨内固定术的临床效果进行分析讨论。[结果]再手术共102例（7．69％，102／1327），其中多次再手术（2次或2次以上）有11例。再手术的主要病因椎间盘再突出58例、椎管相对狭窄或椎节不稳40例及术后椎间隙感染4例。47．06％（48例）再手术行单纯的髓核摘除；19．61％（20例）行全椎板减压；33．33％（34例）行减压植骨内固定术，椎体间植骨融合术16例并呈逐年增加的趋势。分类统计分析结果显示：腰椎间盘突出症首次手术后1a内（≤1a）的再手术率显著高于1a后（〉1a）的再手术率（P〈0．0001），尤其对伴有术后椎节不稳或椎管狭窄患者；再手术率与年龄有强相关性（P〈0．0001），35～49岁年龄段为再手术相对高发年龄。3种再手术方式对于患者的临床疗效有差别但无显著的差异（P=0．1740）；但对于减少多次再手术率有显著的差异，以减压植骨融合内固定术的多次再手术率最低（P=0．049）。[结论]腰椎间盘突出症首次手术后1a内为再手术的相对高发时段，而再手术的方式以减压植骨内固定临床效果相对较佳，椎间融合术可明显减少多次再手术率，临床应用呈逐年增加趋势。     

小切口椎板间开窗髓核摘除术治疗腰椎间盘突出症临床分析

目的：通过评价小切口椎板间开窗髓核摘除术治疗腰椎间盘突出症的手术疗效,探讨其手术的优缺点及注意事项。方法：对96例腰椎间盘突出症患者采用小切口椎板间开窗髓核摘除术进行治疗,其中男48例,女48例;年龄16～75岁,平均46.4岁;病程1个月～30年,平均5年。采用日本骨科学会（JOA）下腰痛评分标准评价其手术后疗效。结果：所有患者均获随访,时间6个月～3.5年,平均1.2年。采用JOA下腰痛评分标准：优34例,良55例,中7例,优良率为92.71%,平均改善率为54.53%。结论：小切口椎板间开窗髓核摘除术能够取得良好的疗效,对腰椎生理结构破坏较小,发生术后腰椎不稳及腰椎术后失败综合征的可能性较低,是目前较好的腰椎间盘突出症手术治疗方式之一。     

腰椎间孔椎间盘突出症（附4例报告）

腰椎间孔椎间盘突出症以往少见，且多通过手术明确诊断。随着影像学的发展及临床认识的深入，此类型腰椎间盘突出症渐多[1-3]。本文就4例该型椎间盘突出症的病理解剖、诊断和手术特点加以探讨。1资料与方法1.1临床资料1991～1994年12月我院共收治椎间扎型腰椎间盘突出症4例，其中男性3例，女性1例，平均年龄42岁。发病到手术时间较短，腰痛及单侧下肢放射性疼痛持续而严重，夜间加重伴失眠。急性痛苦病容，强制体位，腰椎侧弯，平腰，相应侧椎旁压痛、叩击痛、反射痛，坐骨神经走行压痛，相应神经根感觉运动反射受损明显，Lasegue征阳性，…     

椎间盘镜与椎板开窗治疗单节段腰椎间盘突出症疗效对比分析

[目的]比较椎间盘镜下髓核摘除术和椎板开窗髓核摘除术治疗单节段单侧腰椎间盘出症的临床效果及优缺点。[方法]回顾性分析2003年7月-2005年7月手术治疗的单节段椎间盘突出症患者69例，其中应用椎间盘镜手术治疗腰椎间盘突出症患者32例、椎板开窗手术37例。分别比较手术时间、术中出血量、术后卧床时间、术后出院时间、术前术后JOA评分、腰痛及腿痛VAS评分。[结果]椎间盘镜组和椎板开窗组疗效优良率分别为优良率93．7％和91．9％，无显著性差异，同时两组患者术后腿痛缓解无显著性差异；而两组患者在术后腰痛VAS评分、术中出血量、术后卧床时间及术后住院时间有显著性差异，椎间盘镜组要明显优于常规椎板开窗组。[结论]两种术式都能有效缓解腰椎间盘突出症患者的症状，但MED手术创伤小、出血少、术后早期康复快，术后遗留腰痛较轻。     

微创工作通道治疗椎间盘突出症的临床疗效分析

[目的]评价直视下小切口术式治疗椎间盘突出症的可行性及有效性.[方法]本院自2004年3月～ 2010年9月采用开放式小切口术式治疗腰椎间盘突出症患者共445例.男性277例,女性168例;年龄22～58岁(平均46.7岁).随访时间16 ～ 83个月(平均65.1个月),采用腰痛VAS评分及JOA评分.[结果]所有随访对象均无丢失,术前JOA(15分法)评分平均3.12分,末次随访JOA评分平均13.97分;术前VAS腰痛评分平均7.32分,末次随访腰痛VAS评分平均1.59分;术前腿痛VAS评分平均8.74,末次随访腿痛VAS评分平均1.12分;改善率为91.32％,优良率100％.[结论]实行小切口术式治疗腰椎间盘突出症取得了良好的疗效,此种手术方法创伤小,安全有效,可到达微创的效果,与现应用的椎间盘微创治疗技术并不冲突.     

单侧椎弓根螺钉固定关节突融合治疗腰椎间盘突出症

目的评价单侧椎弓根螺钉固定关节突融合治疗腰椎间盘突出的临床疗效。方法2008年12月至2011年12月共收治腰椎间盘突出患者28例,其中初次腰椎间盘突症21例,腰椎间盘突出小切口髓核摘除术后复发5例,MED术后复发2例,均采用单节段单侧椎弓根螺钉固定关节突融合治疗。根据日本骨科协会（Japanese orthopaedic association,JOA）评分法评估术后疗效。结果手术时间平均90min,术中出血平均180mL。术前JOA评分平均12分,术后1年时平均24分。优25例（89．29％）,良2例（7．14％）,可1例（3．57％）,优良率为96．43％。经1～2．5年随访,所有患者腰椎稳定性良好,未发现断钉及症状复发。结论单侧椎弓根螺钉固定是治疗腰椎间盘突出的一种有效方法,但需要严格把握手术适应证。     

Long-term outcomes of standard discectomy for lumbar disc herniation: a follow-up study of more than 10 years

STUDY DESIGN: A retrospective analysis of the long-term outcomes of standard discectomy for lumbar disc herniation. OBJECTIVES: To investigate the long-term outcomes of standard discectomy to address postoperative problems, including residual low back pain and recurrent herniation. SUMMARY OF BACKGROUND DATA: Most previous investigators found that favorable outcomes of standard discectomy were maintained for the long-term postoperative period. Although they observed postoperative complications such as residual low back pain and recurrent herniation, detailed analyses of these results have not been conducted. METHODS: The long-term follow-up results in patients who were observed for a minimum of 10 years after standard discectomy were evaluated by using the Japanese Orthopedic Association scoring system through direct examinations and questionnaires. Radiography also was used in patients who agreed to visit the hospital, and findings were compared with those on preoperative radiographs. RESULTS: The average recovery rate calculated by using Japanese Orthopedic Association scores was 73.5 +/- 21.7%. Even though residual low back pain was found in 74.6% of the patients, only 12.7% had severe low back pain. The majority of the patients with severe low back pain were under 35 years of age at the time of operation, with preoperative advanced disc degeneration. The final Japanese Orthopedic Association scores in the patients with decreased disc height were significantly lower than those in patients with no decrease. However, the disc height of patients with a recurrent herniation was preserved. CONCLUSION: The long-term outcome of standard discectomy in this series was favorable. Although patients with preserved disc height generally had favorable results, the risk of recurrent disc herniation was high in this population.     

改良腰椎板截骨回植治疗失稳性腰椎间盘突出症

目的：评价改良腰椎板截骨回植在失稳性腰椎间盘突出症中的疗效。方法：2009年3月至2011年8月对63例失稳性腰椎间盘突出症的患者行髓核摘除＋椎间融合＋椎弓根螺钉内固定＋改良腰椎板截骨回植手术,男33例,女30例;年龄22～68岁,平均48．4岁;病程3个月～13年,平均38．8个月。患者均有不同程度的腰腿疼痛,x线片、CT及MR检查诊断为失稳性腰椎间盘突出症。观测手术前后ODI和JOA评分、并发症发生率、影像学回植椎板愈合率及腰腿痛复发率。结果：62例患者切口I期愈合,1例11期愈合,无下肢深静脉血栓及椎间隙感染等并发症出现。61倒获1年或以上随访,平均随访时间33个月。术中神经损伤发生2例,硬膜囊损伤发生1例;术后1年回植椎板愈合58例：腰痛复发4例,腿痛复发1例。术后2周、6、12个月的ODI及JOA评分显著优于术前（P〈0．05）。结论：改良椎板截骨回植术治疗失稳性腰椎间盘突出症具有较低的术中神经硬膜囊损伤率和腰腿痛复发率、较高的椎板愈合率和较好的临床评分,是一种安全、有效的新方法,为临床失稳性腰椎间盘突出症手术开辟了一种新的术式。     

经皮内镜椎间孔入路手术治疗老年腰椎间盘突出症的临床分析

目的探讨经皮内镜椎间孔入路手术治疗老年腰椎间盘突出症的适应证,分析手术技术及疗效。 方法回顾性收集辽宁省抚顺市中心医院骨科2016年1月至2018年6月,采用经皮内镜椎间孔入路手术治疗单责任节段老年腰椎间盘突出症患者67例,男性24例,女性43例,年龄60~87岁,平均年龄（68±7）岁。责任节段：L_3~4间盘突出11例,L_4~5间盘突出42例,L₅~S₁间盘突出14例。病程0.5~36个月。采用疼痛视觉模拟评分（VAS）、Oswestry功能障碍指数（ODI）、改良MacNab评价临床疗效。 结果本组均顺利完成手术,手术时间60~150 min,平均（105±18）min。随访6~12个月,平均（7.5±1.6）个月。除1例症状未改善外,其余66例患者腰腿痛症状及神经功能障碍均有不同程度的缓解。术前患者腰痛VAS评分为（3.5±1.2）分,腿痛VAS评分为（8.0±1.1）分,ODI指数为（70±18）,术后6~12个月随访时腰痛VAS评分为（1.7±0.9）分,腿痛VAS评分为（1.0±1.6）分,ODI指数为（17±10）,差异均有统计学意义（t=13.718,t=30.973,t=23.059,均P=0.000）。按照改良MacNab评价标准,优42例,良18例,可5例,差2例,优良率89.55%。无硬膜撕裂、神经根损伤和感染,术中出现颈痛3例,术后出现下肢一过性麻木疼痛5例,下肢疼痛持续残留2例,出现对侧下肢疼痛1例,腰痛明显加重2例,复发1例。 结论具备熟练的椎间孔镜技术,掌握好手术适应证,明确责任阶段,采用经皮内镜椎间孔入路手术治疗老年腰椎间盘突出症可取得良好的近期效果。     

Contralateral recurrent lumbar disc herniation. Results of discectomy compared with those in primary herniation

STUDY DESIGN: The surgical outcomes of patients who underwent discectomy for contralateral recurrent herniation and primary herniation were evaluated. OBJECTIVE: To assess whether the clinical results in patients undergoing surgery for contralateral recurrent disc herniation may be as good as those reported after primary discectomy. SUMMARY OF BACKGROUND DATA: No retrospective or prospective investigation has been conducted on the surgical treatment of contralateral recurrent lumbar disc herniation. METHODS: Sixteen patients who underwent surgery for recurrent disc herniation at the same level as primary disc excision, but on the opposite side, were analyzed prospectively from the recurrence of contralateral radicular pain (Group 1). All patients had reported a satisfactory results after primary discectomy. Fifty consecutive patients who underwent disc excision during the study period, who did not report recurrent radicular pain, were analyzed for comparison (Group 2). Overall patient satisfaction, pain severity, functional outcome, and work status were evaluated. RESULTS: At the 2-year follow-up, the clinical outcome was rated as satisfactory in 14 of 16 patients in Group 1 and in 45 of 50 in Group 2 (P > 0.05). Twelve patients in Group 1 and 42 in Group 2 had resumed their work or daily activities at the same level as before the operation (P > 0.05). Radicular pain was significantly improved in both groups at the 6-month and 2-year follow-ups. At the 6-month follow-up, low back pain was significantly improved only in the patients in Group 2; however, at the 2-year follow-up, low back pain was significantly improved in both groups. CONCLUSIONS: Clinical results in patients reoperated on for contralateral recurrent lumbar disc herniation compare favorably with those reported after primary discectomy. The improvement of pain in the low back and lower limbs reported by the majority of patients 2 years after reoperation suggests that fusion is not needed in this patient population.     

腰椎间盘突出症术后腰椎再手术的疗效及其影响因素分析

目的:分析腰椎间盘突出症术后腰椎再手术的临床效果及其影响因素。方法:回顾性分析我科2005年1月～2009年11月收治的94例腰椎间盘突出症术后腰椎再手术患者的临床资料。根据病史、症状、体征及影像学检查,腰椎再手术的原因包括腰椎间盘突出复发49例(52.1%),腰椎管狭窄症17例(18.1%),初次手术减压不彻底16例(17.0%),邻近节段病变7例(7.4%),其他节段新发腰椎间盘突出5例(5.3%)。再手术前,腰椎JOA评分为15.5±5.6分,腰痛VAS评分为4.5±1.6分,下肢痛VAS评分为7.1±1.9分。再手术均采用后路减压、椎间盘切除、椎弓根螺钉内固定、横突或椎体间植骨融合术。对再手术患者进行随访,并根据VAS、JOA评分及患者主观满意度评价再次手术效果。采用多因素非条件Logistic回归,分析患者性别、年龄、吸烟、既往手术史、既往手术方式、上次术后症状缓解时间、本次病程、再手术前神经损害、本次手术融合节段等变量对手术效果的影响。结果:再手术时间1.6～4.5h,平均2.4h;术中出血量200～1500ml,平均538ml。术中无神经损伤发生;术后发生脑脊液漏7例,切口感染1例,经对症处理均治愈。再手术后随访2～6.5年,平均4.2年。末次随访时,总体优良率78.7%,JOA评分为24.0±6.2分,腰痛VAS评分为1.3±0.9分,下肢痛VAS评分为0.9±1.8分,与术前比较差异均有显著性(P<0.001)。再手术前神经损害、本次病程对手术效果的影响有统计学意义(P<0.05),性别、年龄、吸烟、手术次数、上次术后症状缓解时间、既往手术方式、本次手术减压融合的节段对手术效果的影响无统计学意义(P>0.05)。结论:腰椎间盘突出症术后腰椎再手术依然能够获得较好的临床效果。再手术前神经损害、本次病程是影响手术效果的因素。     

Recurrent lumbar disc herniation after discectomy: outcome of repeat discectomy

BACKGROUND: Recurrent disc herniation after discectomy is relatively lacking in specific studies and is usually reviewed along with other causes of failed disc surgery. The purpose of the current study was to address the outcome in the patients who had recurrent disc herniation treated with repeat discectomy and to identify the factors that may influence the outcome. METHODS: Thirty-nine patients who underwent repeat discectomy for recurrent lumbar disc herniation were retrospectively analyzed. Of these patients, 27 had recurrent disc herniation at the L4 to L5 level, 11 at the L5 to S1, and 1 at the L3 to L4. They almost had the typical presentation of sciatica. The time from prior discectomy to that of recurrence ranged 6 months to 17 years (average, 5 years and 4 months). The Japanese Orthopaedic Association (JOA) score averaged 12 (range, -3 to 18). All patients had a follow-up evaluation at 1 and 15 years (average, 7 years and 8 months) after surgery. RESULTS: Their JOA score increased to 12 to 29 (average, 24), with the recovery rate of 29% to 100% (average, 72%). Twenty-nine patients returned to their previous work status or normal daily activity, 7 had significant improvement, and 3 needed analgesic drugs although they had pain relief to different degrees. CONCLUSIONS: The outcomes of repeat discectomy for recurrent disc herniation were satisfactory. No factors such as age, sex, traumatic events, times of prior surgery, level of herniation, side of recurrence, pain-free interval, duration of recurrence symptoms, walking capacity, the preoperative JOA score, associated spinal stenosis, procedures of revision surgery, and dural tear were found to be of predictive value for a prognosis of revision surgery for recurrent disc herniation (P>.05).     

显微镜和显微内镜下髓核摘除术治疗腰椎间盘突出症

[目的]研究显微镜和显微内镜下髓核摘除术治疗腰椎间盘突出症的临床疗效及差异.[方法]选取两种术式开展初期的各30例病例进行回顾性分析,采用JOA和改良MacNab标准评定手术疗效,统计两组手术时间,切口长度,术中出血最,术后下地时间和围手术期并发症等指标.[结果]60例病例均获得术后一年随访,JOA评分改善和改良Macnab标准评价优良率比较无显著性差异,均取得很好疗效.显微镜组平均手术时间短于显微内镜组,手术切口长于显微内镜组,术中出血量和术后下地时间两组比较无显著性差异.显微内镜组并发症率略高.[结论]两种显微术式均很好的将传统的髓核摘除术微创化,取得了满意的治疗效果.显微镜技术学习曲线难度较低,相对容易掌握,手术适应证广泛,手术并发症率略低,具有一定的优势.     

Microendoscopic discectomy for lumbar disc herniation with bony fragment due to apophyseal separation.

The purpose of this study was to elucidate the feasibility of microendoscopic discectomy (MED) for the treatment of lumbar disc herniation with a bony fragment due to apophyseal separation. Eighteen patients with low back pain and unilateral sciatic pain due to lumbar disc herniation with a bony fragment were treated by MED using the unilateral approach (15 males and three females; mean age, of 28.9 years; mean follow-up period, 21.1 months); 18 age-and sex-matched patients with lumbar disc herniation without a bony fragment treated by MED served as the control group. The clinical outcomes were evaluated using the Japanese Orthopedic Association Score for Low Back Pain (JOA scores; maximum score, 29 points). Evaluation of the results revealed that good surgical outcomes equivalent to those in the control group were obtained in the subjects of LDH with a bony fragment (JOA scores; 14.1+/-3.5 in the patient group vs.15.4+/-2.6 in the control group before surgery; 26.3+/-1.8 in the patient group vs. 26.9+/-1.3 at follow-up after the surgery). Although the mean surgical time was significantly longer in the patient group, there were no intra- or postoperative complications in either group. We conclude that MED using the unilateral approach is a feasible minimally invasive surgical option for patients of lumbar disc herniation with an apophyseal bony fragment.     

Mid- to long-term outcome of disc excision in adolescent disc herniation.

BACKGROUND CONTEXT: Adolescent disc herniation and its surgical treatment have been the subjects of many published clinical series. The majority of these series were heterogeneous; the number of adolescent patients (12-17 years) as opposed to young adults (18-20 years) was generally small and the length of follow-up varied greatly. Although the short-term outcome of disc excision in adolescents was mostly favorable, their long-term outcome is unknown. OBJECTIVES: To evaluate the mid- and long-term results of discectomy in patients younger than 17 years of age. STUDY DESIGN: Retrospective examination of a series of adolescent patients under the age of 17 years who underwent surgery for lumbar intervertebral disc herniation. PATIENT SAMPLE: The medical records of 26 patients (15 males, 11 females, 12-17 years old [average 14.6]) who were operated for lumbar intervertebral disc herniation in three spine centers between 1984 and 2002 were reviewed. These subjects represented the total number of patients meeting the criteria of adolescents undergoing discectomy for lumbar disc herniation in these institutions during the study period. All patients were located and contacted by an independent observer not involved in the care of these patients. Low back pain associated with leg pain was the main clinical symptom in 20 patients (77%), leg pain in 4 (15%), and back pain in 2 (8%). They all underwent posterior disc excision: 23 (88%) patients had one level discectomy, and 3 (12%) had simultaneous discectomy at two levels. The L4-L5 interspace was involved 19 times, and the L5-S1 interspace 10 times. Slipped vertebral apophysis was diagnosed in 4 patients (15%). Twelve of the 26 patients (46%) had a first-degree relative with a history of lumbar disc herniation. OUTCOME MEASURES: Telephone interviews provided follow-up data for 26 patients. Results were classified as excellent, good, moderate, or poor according to current symptom status, the need for additional surgery, the Oswestry Disability Index, and back and leg pain scores. RESULTS: The average time from surgery to follow-up was 8.9 years (range 3-21 years). At follow-up, the clinical results were excellent in 13 patients (50%), good in 4 (15%), moderate in 8 (31%), and poor in 1 (4%). Four subjects (15%) underwent a subsequent disc excision in the lumbar region, and one of them later underwent fusion. CONCLUSIONS: Discectomy provides satisfactory clinical results in young patients with disc herniation. The rate of reintervention (15%) is comparable to that in adults, indicating that discectomy for young patients should be approached similarly to that in adults.     

显微镜下微创治疗腰椎椎间盘突出症的临床疗效观察

目的手术显微镜下完成腰椎椎间盘突出髓核摘除术并观察疗效。方法 2009年1月～2010年1月,行显微镜下椎间盘突出髓核摘除术30例,通过术前及术后1年患者影像学资料观察、腰椎神经功能日本骨科协会（Japa-nese Orthopaedic Association,JOA）评分、痛视觉模拟量表（visual analogue scale,VAS）评分、Oswestry功能障碍指数（Oswestry disability index,ODI）评定手术效果。结果腰椎神经功能JOA评分由术前14.7±4.5分升至术后27.3±2.8分,改善率为（85.5±8.5）%;VAS评分由术前7.9±1.5分下降至术后1.4±0.6分,改善率为（86.4±1.9）%;ODI由术前72.3±1.5恢复至术后15.5±7.8,改善率为（81.5±6.3）%。术后影像学显示突出髓核摘除满意。结论手术显微镜下完成腰椎椎间盘突出髓核摘除术切口小、视野清晰、术中出血量少、骨性结构破坏小,减少对神经根及硬膜囊的手术刺激,安全可靠、效果好,但熟练操作需要较长时间的显微外科基础训练。