椎间盘镜技术微创治疗多节段腰椎间盘突出症

摘要

Objective To evaluate the operation method and clinical efficacy of the minimally invasive treatment of multi-segmen-tal lumbar disc herniation using microendoscopic discectomy. (MED). Methods 52 patients (23 male and 29 female) with age rang-ing from 30~71 years and an average of 53.1 years and with multi-segmental lumbar disc herniation were treated with microendo-scopic discectomy through posterior approach in our hospital between October, 2012 and October 2014. The course of disease ranged from 4 months to 21 years (average, 3.7 years) There were 39 cases of biarticulate intervertebral disk protrusion and 13 cases of triarticular intervertebral disk protrusion. 11 cases with lumbar vertebra mobilization were treated with fully closed-expan-sion type posterior lumbar interbody fusion under endoscope. The clinical efficacy was evaluated according to Macnab criteria. Results After operation, all the patients were followed up for 3~24 months with an average of 11 months. The duration of biarticu-late intervertebral disk protrusion was 50~80 min with an average of 60 min. The duration of those who underwent fully closed-ex-pansion type posterior lumbar interbody fusion increased by 10-30 min with an average of 20min. The amount of bleeding was 50~1 000mL, averaging 300 ml; bleeding of internal vertebral vein was the most common one. Patients can take exercise moderately with waist brace after 3 to 7 days; and the average time of hospitalization was 12 days. Efficacy: 38 cases (73.1%) were remark-able, 10 cases (19.2%) were good, 4 cases (7.7%) were not so well. Postoperative complications: There were 3 cases of dural tear, with no complications such as nerve injury and cage migration. Conclusion Decompression, removal of intervertebral disc and im-plantation of fusion device can be done effectively by microendoscopic discectomy through posterior approach, which is with small trauma and can minimize its infulence on the stability of lumbar spine.%目的：评价椎间盘镜技术治疗多节段腰椎间盘突出症的手术方法及临床疗效。方法2012年10月-2014年10月，采用后路椎间盘技术共治疗多节段腰椎间盘突出症患者52例，男23例，女29例；年龄30~71岁，平均53.1岁。病程4个月~21年，平均3.7年。两个节段椎间盘突出者39例，3个节段椎间盘突出者13例。11例存在腰椎失稳者行镜下“全合”膨胀式椎间融合器椎间融合术。依据Macnab评分标准评价临床疗效。结果术后随访3~24个月，平均11个月。两个节段手术时间50~80 min，平均60 min，伴“全合”膨胀式椎间融合器椎间融合时手术时间增加10~30 min，平均20 min。术中出血50~1000 mL，平均300 mL；出血量较多者主要为椎管内静脉丛出血。术后第3~7天即可佩戴腰围适度下床活动；住院时间平均12 d。疗效院优38例（73.1%），良10例（19.2%），可4例（7.7%）。术后并发症院术中硬膜囊撕裂3例，无神经损伤、融合器移位等并发症发生。结论后路椎间盘镜技术在尽可能减少对腰椎稳定性的影响下，可以实现对多节段腰椎间盘突出症的彻底减压、椎间盘的摘除及融合器的植入，手术创伤小，治疗效果优良。