复发性腰椎间盘突出症；MED_

内窥镜下治疗复发性腰椎间盘突出症

http://www.100md.com 《中华首席医学网》 2006年第13期

复发性腰椎间盘突出症；MED,,复发性腰椎间盘突出症；,MED,1材料和方法,2结果,3讨论,参考文献：

     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例术中改为开放式外，18例均在MED方式下完成手术。全部18例得到随访05~25 a，平均随访15 a。据Macnab评分，优为7例，良为9例，可为2例，差为0例，优良率8889%。JOA评分由术前平均(961±340)分提高到末次随访时平均(2617±260)分，有效率为8632%。[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之一。

    关键词：复发性腰椎间盘突出症； MED

    Operative management for the recurrent lumbar disc herniation by microendoscopy discectomy technique∥ZHANG Yadong,ZHANG Xiangyang,WANG Jia，et alDepartment of Orthopedics,Shanghai Changning Central Hospital,Shanghai 200336,China

    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 approachThere were 13 cases of ipsilateral protrusion and 2 cases of contralateral protrusion,3 cases of adjacent segment protrusionAll 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 operatingAll cases were followed up from 6 months to 25 years,averaged 15 yearsPostoperative JOA score was improved from preoperative average (961±340)° to average (2617±260) °,the rate of improvement final was 8632%In terms of Macnab scoring system,the satisfactory rate was 8889%[Conclusion]MED technique is an effective method for recurrent lumbar herniation,but the operator needs lots of experience in minimal invasive spine surgery ......

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