| 显微内窥镜下髓核摘除治疗腰椎间盘突出症术中并发症原因分析及防治措施 |
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Received:November 16, 2012
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| 作者 | Author | 单位 | Unit | E-Mail |
| 李树文 |
LI Shu-wen |
内蒙古医科大学第二附属医院微创脊柱外科, 内蒙古 呼和浩特 010030 |
Department of Minimally Invasive Spinal Surgery, the Second Affiliated Hospital of Inner Mongolia Medical College, Huhhot 010030, Inner Mongolia, China |
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| 银和平 |
YIN He-ping |
内蒙古医科大学第二附属医院微创脊柱外科, 内蒙古 呼和浩特 010030 |
Department of Minimally Invasive Spinal Surgery, the Second Affiliated Hospital of Inner Mongolia Medical College, Huhhot 010030, Inner Mongolia, China |
nmgyhp0471@126.com |
| 吴一民 |
WU Yi-min |
内蒙古医科大学第二附属医院微创脊柱外科, 内蒙古 呼和浩特 010030 |
Department of Minimally Invasive Spinal Surgery, the Second Affiliated Hospital of Inner Mongolia Medical College, Huhhot 010030, Inner Mongolia, China |
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| 白明 |
BAI Ming |
内蒙古医科大学第二附属医院微创脊柱外科, 内蒙古 呼和浩特 010030 |
Department of Minimally Invasive Spinal Surgery, the Second Affiliated Hospital of Inner Mongolia Medical College, Huhhot 010030, Inner Mongolia, China |
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| 杜志才 |
DU Zhi-cai |
内蒙古医科大学第二附属医院微创脊柱外科, 内蒙古 呼和浩特 010030 |
Department of Minimally Invasive Spinal Surgery, the Second Affiliated Hospital of Inner Mongolia Medical College, Huhhot 010030, Inner Mongolia, China |
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| 武海军 |
WU Hai-jun |
内蒙古医科大学第二附属医院微创脊柱外科, 内蒙古 呼和浩特 010030 |
Department of Minimally Invasive Spinal Surgery, the Second Affiliated Hospital of Inner Mongolia Medical College, Huhhot 010030, Inner Mongolia, China |
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| 孟格栋 |
MENG Ge-dong |
内蒙古医科大学第二附属医院微创脊柱外科, 内蒙古 呼和浩特 010030 |
Department of Minimally Invasive Spinal Surgery, the Second Affiliated Hospital of Inner Mongolia Medical College, Huhhot 010030, Inner Mongolia, China |
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| 期刊信息：《中国骨伤》2013年26卷，第3期，第218-221页 |
| DOI：10.3969/j.issn.1003-0034.2013.03.011 |
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目的：分析显微内窥镜下髓核摘除术(MED)治疗腰椎间盘突出症术中并发症的发生原因,总结预防及处理办法。
方法：回顾性分析2001年10月至2012年1月,采用显微内窥镜下髓核摘除治疗腰椎间盘突出症的患者851例,男469例,女382例;年龄16～75岁,平均42.5岁;病程1～18个月,平均3个月。突出间隙;L3,4 24例,L4,5 418例,L5S1 409例。主要症状为腰痛伴下肢放射性疼痛、麻木,其中单侧下肢症状者729例,双侧下肢症状者122例,相应神经支配区感觉、肌力、反射异常及肌肉萎缩4项检查至少2项出现异常,神经牵拉试验阳性,CT或MRI表现与临床症状、体征相吻合。851例患者未同时合并腰椎失稳、椎管狭窄患者,未包括高位腰椎间盘突出症及合并马尾神经综合征患者。记录术中并发症的发生情况。
结果：依据Macnab 标准,总体优良率为87.5%(745/851),与开放手术相似。1例因设备故障中转为切开手术,1例术后11 d因突发心肌梗塞死亡,2例于术后1 h内出现急性硬膜外血肿。发生硬脊膜损伤28例,发生率3.29%(28/851).神经根牵拉伤38例,发生率4.46%(38/851);腹膜后血肿1例,不完全性马尾损伤2例,不完全性神经根断裂2例。
结论：熟练的镜下止血技巧、精细的操作是预防MED术中并发症的重要因素,及时发现及时处理是防治显微内窥镜下髓核摘除术术中并发症的有效措施。 |
| [关键词]:椎间盘移位 内窥镜检查 外科手术,微创性 手术中并发症 |
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| Analysis of intraoperative complications of microendoscopic disectomy and corresponding preventive measures |
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Abstract:
Objective: To analyze the reasons of intraoperative complications of microendoscopic disectomy (MED) and corresponding preventive measures.
Methods: From October 2001 to January 2012,the data of 851 patients with lumbar disc herniation underwent MED were retrospectively analyzed. There were 469 males and 382 females with an average age of 42.5 years ranging 16 to 75. Course of disease was from 1 to 18 months with an average of 3 months. The segments of herniated disc including L3,4 of 24 cases,L4,5 of 418 cases and L5S1 of 409 cases. Main symptoms included low back pain with lower extremity radial pain and numbness. Of them,unilateral lower extremity symptom was in 729 cases and bilateral symptom was in 122 cases. There were at least 2 abnormal signs in the four signs which including feeling anormaly,muscle strength anormaly,dysreflexia and muscle atrophy. Distraction test of nerve was positive. CT or MRI findings must coincide with the clinical symptoms and signs. No lumbar instability,spinal stenosis,the upper lumbar disc herniation or combined with cauda equina nerve syndrome were found in 851 patients. The intraoperative complications were recorded and analyzed for the reasons of the intraoperative complication and related prevention measures.
Results: According to the Macnab standard,424 cases obstained excellent results,321 good,106 fair,with excellent and good rate of 87.5%. The result was similar to the traditional open operation. One cases transferred to open operation due to equipment breakdown,1 case died for myocardial infarction at 11 days after the operation,2 cases occurred acute epidural hematoma in 1 hour after operation. Injury of dura mate of spinal cord occurred in 28 cases and incidence rate was 3.29%(28/851);traction injury of nerve root occurred in 38 cases and incidence rate was 4.46%(38/851). One case occurred in retroperitoneal hematoma,2 cases in incomplete cauda equina injury and 2 cases in incomplete nerve root breakage.
Conclusion: Skilled endoscopic hemostasis techniques,careful and meticulous operation is very important for the prevention of intraoperative complications. Moreover,timely finding and treating the complications was effective measures to prevent the complications. |
| KEYWORDS:Intervertebral disk displacement Endoscopy Surgical procedures,minimally invasive Intraoperative complications |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 李树文,银和平,吴一民,白明,杜志才,武海军,孟格栋.显微内窥镜下髓核摘除治疗腰椎间盘突出症术中并发症原因分析及防治措施[J].中国骨伤,2013,26(3):218~221 |
| 英文格式: | LI Shu-wen,YIN He-ping,WU Yi-min,BAI Ming,DU Zhi-cai,WU Hai-jun,MENG Ge-dong.Analysis of intraoperative complications of microendoscopic disectomy and corresponding preventive measures[J].zhongguo gu shang / China J Orthop Trauma ,2013,26(3):218~221 |
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