临床医学毕业内窥镜下治疗复发性腰椎间盘突出症.docVIP

XX大学 毕业论文 内窥镜下治疗复发性腰椎间盘突出症 姓 名： 2014年6月25日 内窥镜下治疗复发性腰椎间盘突出症 作者：张亚东，张向阳，王嘉，曹徳良 【关键词】复发性腰椎间盘突出症；MED 摘 要：［目的］探讨对复发性腰突症患者行显微内窥镜下髓核切除术 (microendoscopic discectomy, MED)治疗的可行性及有效性。［方法］19例有 不同初次手术史，已明确诊断为复发性腰突症的患者接受MED手术。［结果］ 除1例术屮改为开放式外，18例均在MED方式下完成手术。全部18例得到随 访05?25 a,平均随访15 a。据Macnab评分，优为7例，良为9例，可为2例， 差为0例，优良率8889%o JOA评分由术前平均(961 ±340)分提高到末次随访时 平均(2617±260)分，有效率为8632%o ［结论］对于术前影像学上无明显腰椎不 稳的复发性腰突症患者，只要遵循微创手术原则，掌握微创手术技巧，操作仔细, MED术也是治疗复发性腰突症较好的有效方法Z—。 关键词：复发性腰椎间盘突出症； MED Abstract： ［Objective］ To investigate the surgical feasibility and efficiency with microendoscopy discectomy technique for the recurrent lumbar disc herniation ［Method ］ Ninteen cases underwent disc excision with different operative approaches, 11 cases had undergone previous surgery with MED,7 cases with conventional approach,2 cases removing whole vertebrate plate approach,3 cases removing half vertebrate plate approach,2 cases with minor vertebrate plate window approachThere were 13 cases of ipsilateral protrusion and 2 cases of contralateral protrusion,3 cases of adjacent segment protrusionAll of these cases were revisioned by MED except for 1 case ［Result］ Eighteen cases were finished by MED technique successfully except for 1 case which was changed to open operatingAll cases were followed up from 6 months to 25 years,averaged 15 yearsPostoperative JOA score was improved from preoperative average (961 ±340)° to average (2617±260) °,the rate of improvement final was 8632%In terms of Macnab scoring system,the satisfactory rate was 8889% [Conclusion] MED technique is an effective method for recurrent lumbar herniation,but the operator needs lots of experience in minimal invasive spine surgery Key words： Recurrent lumbar disc herniation; Microendoscopic discectomy (MED) 对复发性腰椎间盘突岀症治疗方法的选择是一个颇有争议的问题。更多的 患者由于二次开放式手术可能带来的腰椎不稳定而需行内固定手术，以不影响远 期效果。随着目前外科微创化的发展趋势，文献报道有限化治疗复发性腰椎间盘 突出症也已取得较好的疗效〔1、2)。近年来，随着显微内窥镜下髓核切除术 (MED)的开展，随访中也发现了术后椎间盘复发病例。基于作者掌握的微创 技术结合复发性腰突症特点，在2002年8月?2005年9月作者应用MED技术治 疗复发性腰椎间盘突出症18例，取得较好