663例MED术后43例再手术原因分析.docVIP

663例MED术后43例再手术原因分析 　　doi：10.3969/j.issn.1007-614x.2014.16.13 　　摘 要 目的：分析MED（后路显微椎间盘镜手术）术后再手术的原因。方法：2000年1月-2010年1月收治单节段腰椎间盘突出症患者663例，给予MED治疗，观察临床疗效。结果：MED治疗的优良率90.8%，再手术患者43例，其中侧隐窝狭窄未解除18例，原位椎间盘突出13例，临近节段椎间盘突出6例，腰椎不稳2例，椎间盘感染2例，非典型椎间盘突出椎间盘节段定位错误1例，游离性椎间盘突出未发现1例。结论：隐窝狭窄未解除、原位椎间盘突出、临近节段椎间盘突出是后路椎间盘镜治疗腰椎间盘突出症手术失败的主要原因。 　　关键词 MED治疗 腰椎间盘突出症 原因分析 　　Analysis of the causes of reoperation of 43 cases after MED in 663 cases 　　Yang Xingyong1，Hou Weiguang2 　　Luzhou Medical College（Luzhou City，Sichuan），6460001 　　Department of Orthopedics，Chengdu Three Six Three Hospital （Chengdu City，Sichuan），6100412 　　Abstract Objective：To analyze the cause of postoperative reoperation of MED.Methods：663 cases with single segmental lumbar disc disease were selected from January 2000 to January 2010.They were treated with MED treatment.The clinical effect was observed.Results：The excellent and good rate of MED treatment was 90.8%.43 cases were given reoperation.18 cases were lateral recess stenosis unwinding.13 cases were in situ protrusion of the intervertebral disc.6 cases were adjacent segment disc herniation.2 cases were lumbar instability.2 cases were infection of intervertebral disc.1 case was atypical lumbar disc herniation of intervertebral disc section positioning error.1 case was undiscovered dissociation protrusion of intervertebral disc.Conclusion：The lateral recess stenosis unwinding，in situ protrusion of the intervertebral disc and adjacent segment disc herniation are the major causes of operation failure of microendoscopic discectomy in the treatment of lumbar disc herniation. 　　Key words MED treatment；Lumbar disc herniation；Cause analysis 　　资料与方法 　　2000年1月-2010年1月收治单节段腰椎间盘突出症患者663例，男401例，女262例，年龄14～73岁，平均42.3岁。经临床症状、体征、查体、影像学检查（包括CT及MRI）确诊并行MED治疗，术后按常规预防感染、脱水等对症治疗，通过电话、邮件及门诊，行1～10年的临床随访，平均随访时间4.5年。 　　手术方法：患者取俯卧位腹部悬空，行硬膜外麻醉。常规消毒铺巾。C臂定位，确定位置后沿病变椎间盘棘突旁开0.5cm处插入导针。沿导针方向切开皮肤0.8～1.0cm，扩大手术通道满意后固定，安装、检查摄像系统正常。检查视野，局部止血。剥离至黄韧带及椎板，咬骨钳部分上位椎体椎板下缘及关节突部分骨质咬除上位椎体椎板下缘和关节突内侧部分骨质，显