内窥镜下手术治疗腰椎间盘退变性疾病的并发症

Complications of microendoscopic operation for degenerative disc diseases

中文关键词:  内窥镜  椎间盘退变疾病  微创  并发症  腰椎

英文关键词:Microendoscopic operation  Ｄegenerative disc disease  Ｍinimally invasion  Ｃomplication  Lumbar spine

中文摘要:

  【摘要】 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。

英文摘要:

  【Abstract】　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 cerebrospinal 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.