摘要
目的探讨内镜治疗腰椎间盘突出症术中神经根解剖变异时的对策。方法在近一年半内运用经后路椎间盘镜下腰椎间盘摘除术(MDE)治疗腰椎间盘突出症168例,术中发现4例神经根变异,发生率2.4%。按Kadish分型:Ⅱ型2例,Ⅳ型2例。其中L4,5间隙1例,L5S1间隙3例。4例神经根变异术中镜下经细致辨别和适当扩大显露等操作,完成手术。结果4例术后没有神经根损伤,术前症状体征消失,随访没有复发。结论腰骶神经根变异虽然发生率低,但术中应重视。对术前突出节段与神经根损害、影像学突出与临床症状不完全符合时应考虑神经根变异可能。MED手术视野清晰,镜下能清晰辨别突出椎间盘与神经根和变异神经根的毗邻关系,可以有效防止神经根损伤。
Objective To investigate operation countermeasure to lumbar disc herniation undergoing the microendoscopic discectomy（MED） when the lumbosacral nerve root anomaly occured. Methods One hundred and sixty-eight cases of lumbar discs herniafion were treated with MED in the past year and a half. In which 4 cases of nerve root anomalies were found. The incidence was 2.4%. There were Type Ⅱ 2 cases and type Ⅳ 2 cases according to Kadish type,which at L4,5 1 case and L5S1 3cases. Four nerve root anomalies cases were operated undergoing meticulous show identification and appropriate expansion by MED. Results No nerve root injury happened in these 4 neve root anomalies-eases post MED, Preoperative symptoms and signs disappeared, and no reeurrenee by follow-up. Conclusion The lumbosaeral nerve root anomalies should be pay attention though the low incidence. It should be considered when the preoperative protruding gap does not accord completely with nerve root damage and imaging protruding does not accord completely with clinical symptoms. MED could effectively prevent the nerve root injurty because of its distinct vision and clearly identifying adjaeet relatiouship between protruding disc and nerve root and anomaly nerve root.
出处
《四川医学》
CAS
2008年第6期675-676,共2页
Sichuan Medical Journal
