跪俯卧位腰间盘镜治疗腰间盘突出症及腰椎管狭窄症262例分析

[目的]探讨腰间盘镜治疗腰椎间盘突出症及腰椎管狭窄症的手术方法、适应证及疗效。[方法]回顾性研究2002年7月~2006年12月大连医科大学第一临床学院采用腰间盘镜(MED)治疗腰间盘突出症并选择性应用于治疗腰椎管狭窄症患者共262例。其中,男96例,女166例,平均年龄34.2岁,病程平均2年2个月。突出间隙L3/4 27例,L4/5 143例,L5/S1 80例,突出部位:中央型52例,旁侧型210例,合并有后纵韧带钙化或椎体后缘骨质增生57例,伴腰椎管狭窄69例。手术均采用跪俯卧位,间盘镜下间盘摘除,对伴有单节段椎管狭窄患者采用椎管扩大开窗减压、神经根探查松解、神经根管减压术。手术时间20~150 min,平均出血25 mL。术后间盘称重平均2.9 g,术后第1天即可起床、进食及排便。[结果]本组262例病例平均随诊15个月,疗效参考Nakai标准。其中,优199例(76%),良35例(16.9%),可17例(6.6%),差1例(0.5%),优良率达到92.9%。[结论]跪俯卧位下采用MED治疗腰间盘突出症及部分腰椎管狭窄症患者有其优越性。

Treat lumbar discs herniation and lumbar spinal stenosi by microendoscopic discectomy on kneeling-bow position

[Objective] To discuss the best operative technique,indication,efficacy to treat lumbar disc herniation and lumbar spinal stenosis by microendoscopic discectomy(MED).[Methods] To study retrospectively 262 cases of lumbar disc herniation and selected lumbar spinal stenosis from June 2002 to December 2006 were operated upon with MED.Male 96 cases,Female 166 cases;average ages was 34.2 years,average illness period was 2 years and 2 months.The herniaion segment : L3/4 27 cases,L4/5 143 cases,L5/S1 80 cases.The herniation part : central type 52 cases,lateral type 210 cases,association with ossification of the posterior longitudinal ligament or osteophyma 57 cases,with Lumbar spinal stenosis 69 cases.All the procedure on kneeling-bow position,were exercised,the Lumbar sinal stenosis cases teated with enlargement of the neural canal,fenestration,nerve root exploration and depression,the operation time 20~150 min.average bleeding 25 mL.intervertebral discs weight 2.9 g,patient could get off bed to the washroom in the first postoperative day.[Results] All 262 cases were followed average 15 months,the coutcome was excelling in 199 cases(76%),good in 35 cases(67%),fair in 17 cases(6.6%),and 1 case was poor according to the Nakai standard scale.[Conclusion] There are advantage in treating lumbar disc herniaion and selected lumbar spinal stenosis at the kneeling-bow positon.