From January 2005 to June 2010,497 patients with lumbar disc herniation were treated by posterior discectomy, which data were analyzed retrospectively. There were 395 males and 102 females, ranging in age from 20 to 78 years with an average of 43.7 years. Among them,405 cases were in single gap,86 cases were in double gaps and 6 cases were in three gaps. The complication of operation and solution was analyzed. Results: The mean operative time was 70 min (from 45 to 210 min), and the mean hospitalization was 10 d (from 5 to 20 d). Forty-seven cases suffered operative complications. There were 16 cases of wrong location of segments( 14 cases occurred in operation and 2 occurred after operation), 15 cases of less alleviation or aggravation of nerve symptoms (12 cases were poor alleviation and 3 cases were aggravation), 10 cases of urinary retention ,5 cases of cerebrospinal fluid leakage and 1 case of infection. Conclusion: Minimally invasive process of posterior discectomy in treating lumbar disc herniation may complicate with many problems. The operative effects can be improved and the complication can be decreased if the ability of location is improved, surgical indications is correct and the operation is exactly performed.%目的:分析腰椎间盘突出症后路开窗髓核摘除术切口微创化过程中常见问题及探讨对策.方法:回顾性分析2005年1月至2010年6月采用小切口后路开窗髓核摘除术治疗的497例腰椎间盘突出症患者的临床资料,男395例,女102例;年龄20～78岁,平均43.7岁;单间隙405例,双间隙86例,三间隙6例.分析手术相关并发症并探讨对策.结果:手术时间45～210 min,平均70 min,术后住院时间5～20 d,平均10d.出现手术相关问题者47例,其中节段定位错误16例(术中发现14例、术后发现2例),神经症状缓解欠佳或加重15例(欠佳12例、加重3例),尿潴留10例,脑脊液漏5例,感染1例.结论:腰椎间盘突出症后路开窗髓核摘除术在微创化改良过程中可能出现很多问题,努力提高病变间隙定位能力、正确把握手术适应证及熟练掌握手术操作技巧有利于提高手术疗效和减少并发症.
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