显微镜辅助通道下极外侧型腰椎间盘突出切除术△

Microscope-channel assisted discectomy of extreme lateral lumbar disc herniation

摘要:

[目的]介绍改良显微镜辅助通道下手术治疗极外侧型腰椎间盘突出症的手术方法及初步临床结果。[方法]1 例患者行上述手术。患者采用俯卧位，旁中央入路，微创通道放置于下位椎体上关节突肩部，通道暴露范围为上关节突上外侧，部分上位椎板峡部外侧，横突间韧带。显微镜辅助下磨除上关节突上外侧缘，保护椎板峡部骨质，暴露椎间孔外口，向内倾斜通道，探查椎间孔及孔内区域。切除突出椎间盘，探查神经根。[结果] 患者手术顺利，手术时间 78 min，术中出血量 50 mL， 术后患肢疼痛消失，直腿抬高试验阴性，改良 MacNab 法评价疗效为优，疼痛视觉模拟评分 （visual analogue scale, VAS）由术前的 9 分降低至术后第 2 d 的 3 分、术后 1 个月的 1 分。术后 CT 示关节突关节面及椎板峡部保留完整。[结论]改良显微镜辅助通道下手术治疗极外侧型腰椎间盘突出症，具有微创、神经减压直接、确切、对腰椎稳定性影响小等优点。

Abstract:

[Objective] To introduce the surgical technique and preliminary clinical results of modified microscopy-channel assisted discectomy of extreme lateral lumbar disc herniation. [Methods] A patient underwent the abovesaid operation. The patient was placed in a prone position with a para-midline approach made. A minimally invasive channel was placed on the shoulder of the superior facet of the lower vertebrae to exposure the upper lateral articular process, part of the lateral isthmus of the upper vertebrae, and the inter-transverse ligament. With the aid of microscope, the upper lateral margin of the superior articular process was removed, while the isthmus remained, to expose the external outlet of the foramen. Turning the channel forward the foramen and the internal foramen region, the herniated disc was removed and the nerve root was released. [Results] The operation was conducted successfully, with operation time of 78 min and intraoperative blood loss of 50 mL. The pain of the affected limb disappeared after the operation, while the straight leg raise test turned to be negative, and the modified MacNab grade was marked as best. The visual analogue scale (VAS) decreased from 9 before surgery to 3 2 days after operation and 1 a month after surgery. Postoperative CT showed that the articular surface of the facet and the isthmus of the lamina were intact. [Conclusion] This modified microscope -channel assisted discectomy for extreme lateral lumbar disc herniation has the advantages of minimally invasive surgery, direct and precise nerve decompression, and few impact on the stability of the lumbar spine.