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

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

关键词:  跪俯卧位  腰间盘镜  腰间盘突出症  腰椎管狭窄症

Key words:  kneeling-bow position  microendoscopic discectomy  lumbar disc herniaion  lumbar spinal stenosis

摘要:

［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。

Abstract:

［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.［Conclusions］There are advantage in treating lumbar disc herniaion and selected lumbar spinal stenosis at the kneeling-bow positon.