后路椎间盘镜手术治疗腰椎间盘突出症626例疗效剖析.docVIP

后路椎间盘镜手术治疗腰椎间盘突出症626例疗效剖析 　　【摘要】目的 探讨使用后路椎间盘镜治疗腰椎间盘突出症的疗效。方法回顾性分析2008年11月～2015年8月住院确诊为腰椎间盘突出症的626例患者的临床资料，其中男383例，女243例，年龄18～75岁，平均47.3岁，对病变节段均行后路椎间盘镜下髓核摘除术治疗，随访观察其临床疗效。结果所有患者均顺利完成手术且均获得随访，随访时间10个月～6年，平均3年5个月。根据Nakai标准评定，优447例，良129例，可37例，差13例，优良率92%。结论在具有熟练的操作技能及严格掌握适应证的前提下，经后路椎间盘镜治疗腰椎间盘突出症患者可取得较为满意的临床疗效，值得临床推广应用。 　　【关键词】腰椎间盘突出症；椎间盘镜：微创 　　中图分类号：R687.3文献标识码：ADOI：10.3969/j.issn.1003-1383.2017.06.007 　　【Abstract】ObjectiveTo investigate the curative effect of posterior microendoscopic discectomy（MED）in the treatment of prolapse of lumbar intervertebral disc.MethodsClinical data of 626 patients who were diagnosed with prolapse of lumbar intervertebral disc from November，2008 to August，2015 were retrospectively analyzed.All patients included 383 males and 243 females，aged from 18 to 75 years，with an average age of 47.3 years.They were all given posterior approach MED for lesion segments.In addition，patients were followed up and clinical efficacy was observed.ResultsAll patients completed the operation successfully and were followed up for 10 months to 6 years，with an average of 3 years and 5 months.According to the Nakai standard evaluation，447 cases were excellent，129 cases were good，37 cases were eligible，13 cases were poor，and good and excellent rate was 92%.ConclusionPosterior MED can achieve satisfactory clinical efficacy in the treatment of prolapse of lumbar intervertebral disc under the premise of skilled operation skills and strict grasp of indications，which is worthy of clinical application. 　　【Key words】prolapse of lumbar intervertebral disc；microendoscopic discectomy；minimally invasive 　　引起腰腿痛的常见原因是椎间盘变性损坏后髓核纤维环破裂处突出刺激或压迫马尾神经造成的，即所谓的腰椎间盘突出症[1]。既往对该病常采用开放手术治疗，虽然术后大部分病人的症状均能得到缓解或根治，但其缺点是创伤大、失血量多、术后恢复慢，并且影响了脊柱的稳定性。因此在确保疗效相当的前提下选择一种创伤较小的手术显得至关重要。目前后路椎间盘镜椎间盘切除术（microendoscopic discectomy，MED）治疗腰椎间盘突出症的效果已得到公认[2～3]，MED因操作空间狭窄，对操作者的要求较高，其适应证要比传统手术严格。如操作者欠熟练，会导致疗效欠佳甚至出现严重的并发症。因此严格的病例选择和全面的术前分析，辅以熟练的手术操作，是获得较为满意疗效的必要条件。我院2008年11月～2015年8月应用后路椎间盘镜髓核摘除治疗腰椎间盘突出症626例