中国脊柱脊髓杂志
中國脊柱脊髓雜誌
중국척주척수잡지
CHINESE JOURNAL OF SPINE AND SPINAL CORD
2009年
12期
916-920
,共5页
易伟宏%黄曹%陈开林%胡广询%王锡三%王敏%王尔天%刘赫%罗万荣%何聪
易偉宏%黃曹%陳開林%鬍廣詢%王錫三%王敏%王爾天%劉赫%囉萬榮%何聰
역위굉%황조%진개림%호엄순%왕석삼%왕민%왕이천%류혁%라만영%하총
内窥镜%椎间盘退变疾病%微创%并发症%腰椎
內窺鏡%椎間盤退變疾病%微創%併髮癥%腰椎
내규경%추간반퇴변질병%미창%병발증%요추
Microendoscopic operation%Degenerative disc disease%Minimally invasion%Complication%Lumbar spine
目的:总结内窥镜下手术治疗腰椎间盘退变疾病的并发症发生情况,探讨相关防治措施.方法:2000年12月～2008年6月我院采用METRx内窥镜系统手术治疗腰椎间盘退变疾病患者476例,男295例,女181例;年龄22～73岁,平均36.5岁.单纯椎间盘突出症228例,合并神经根管狭窄112例,椎管狭窄66例,椎间盘钙化63例,腰椎失稳9例;单节段415例,双节段61例.获得至少24个月随访的患者135例.统计术中、术后早期及术后中长期并发症的发生情况.结果:本组患者术中发生并发症38例,发生率7.98%,其中节段定位错误2例,置管偏差17例,硬膜囊损伤12例,神经根及马尾神经损伤4例,大血管损伤1例,髓核钳断裂2例;术后早期发生并发症5例,其中髓核遗漏2例,椎间隙感染、伤口感染、脑脊膜炎各1例;术后中长期并发症6例,其中同节段复发4例,椎间失稳2例.开展内窥镜下手术前50例中发生并发症的病例占所有并发症病例数的71.4%;术中并发症所占比率为77.6%;32例为合并椎管狭窄患者.结论:内窥镜下手术治疗腰椎间盘退变疾病有一定的并发症,镜下操作的熟练程度、手术适应证的选择与手术并发症有关.
目的:總結內窺鏡下手術治療腰椎間盤退變疾病的併髮癥髮生情況,探討相關防治措施.方法:2000年12月～2008年6月我院採用METRx內窺鏡繫統手術治療腰椎間盤退變疾病患者476例,男295例,女181例;年齡22～73歲,平均36.5歲.單純椎間盤突齣癥228例,閤併神經根管狹窄112例,椎管狹窄66例,椎間盤鈣化63例,腰椎失穩9例;單節段415例,雙節段61例.穫得至少24箇月隨訪的患者135例.統計術中、術後早期及術後中長期併髮癥的髮生情況.結果:本組患者術中髮生併髮癥38例,髮生率7.98%,其中節段定位錯誤2例,置管偏差17例,硬膜囊損傷12例,神經根及馬尾神經損傷4例,大血管損傷1例,髓覈鉗斷裂2例;術後早期髮生併髮癥5例,其中髓覈遺漏2例,椎間隙感染、傷口感染、腦脊膜炎各1例;術後中長期併髮癥6例,其中同節段複髮4例,椎間失穩2例.開展內窺鏡下手術前50例中髮生併髮癥的病例佔所有併髮癥病例數的71.4%;術中併髮癥所佔比率為77.6%;32例為閤併椎管狹窄患者.結論:內窺鏡下手術治療腰椎間盤退變疾病有一定的併髮癥,鏡下操作的熟練程度、手術適應證的選擇與手術併髮癥有關.
목적:총결내규경하수술치료요추간반퇴변질병적병발증발생정황,탐토상관방치조시.방법:2000년12월～2008년6월아원채용METRx내규경계통수술치료요추간반퇴변질병환자476례,남295례,녀181례;년령22～73세,평균36.5세.단순추간반돌출증228례,합병신경근관협착112례,추관협착66례,추간반개화63례,요추실은9례;단절단415례,쌍절단61례.획득지소24개월수방적환자135례.통계술중、술후조기급술후중장기병발증적발생정황.결과:본조환자술중발생병발증38례,발생솔7.98%,기중절단정위착오2례,치관편차17례,경막낭손상12례,신경근급마미신경손상4례,대혈관손상1례,수핵겸단렬2례;술후조기발생병발증5례,기중수핵유루2례,추간극감염、상구감염、뇌척막염각1례;술후중장기병발증6례,기중동절단복발4례,추간실은2례.개전내규경하수술전50례중발생병발증적병례점소유병발증병례수적71.4%;술중병발증소점비솔위77.6%;32례위합병추관협착환자.결론:내규경하수술치료요추간반퇴변질병유일정적병발증,경하조작적숙련정도、수술괄응증적선택여수술병발증유관.
Objective:To summarize complications of microendoscopic orperation (METRx) for degenerative disc diseases and explore the way of prevention and treatment.Method:476 patients with lumbar degenerative disc diseases were treated by microendoscopic operation (METRx) from Dec. 2000 to Jun. 2008.There were 295 males and 181 females,with average age 36.5 years (range,22-73 years),including 228 cases of simple disc hernaition, 112 with lateral recess stenosis,66 with spinal stenosis,63 with disc calicifaction and 9 with instability .Single segment involved in 415 cases, and double segments in 61 cases. 135 patients were followed up at least two years.The complications in peri-operative period and at early or long-middle term in post-operative period were observed.Result: There were 38 patients with complication, the peri-operative rate of complication was 7.98% .including 2 subjects with localization error of the level and 17 with deviated tube, 12 with disrupture of dural sac,4 with injury of nerve root or caudal nerve,one with rupture of greater artery.2 forceps of nucleus removal were ruptured.There were 5 subjects with early postoperative complications, including two subjects with nucleus omission,one subject with infection of intervertebral disc,incision and cere-brospinal meningitis, respectively .There were 6 subjects with medium-term complications after operation including four cases of nucleus pulposus recurrent and two cases of lumbar instability.The complications occurred in the first fifty cases of the microendoscopic operation accounted for 71.4% of total complications.The rate of peri-operative complications was 77.6%.Conclusion: There are some complications of microendoscopic operation for degenerative disc disease,which are related to surgeons' experiences of METRx manipulation and the selection of the indications.
