中国脊柱脊髓杂志2008年第l8卷第7期ChineseJournalofineand印inalc0，2008，Vo1．18，，v0．7489经椎间孔显微内窥镜下手术治疗极外侧型腰椎间盘突出症银和平，吴一民，李树文，白明，刘聪，曹振华(内蒙古医学院第二附属医院微创脊柱外科010030呼和浩特市)【摘要】目的：探讨在显微内窥镜辅助下椎管外经椎间孑L手术治疗极外侧型腰椎间盘突出症的临床效果。方法：2005年2月～2007年4月对29例极外侧型腰椎间盘突出症患者采用显微内窥镜下经椎管外椎间孑L人路切除突出椎间盘．松解神经根，解除脊髓压迫；7例合并腰椎失稳者除切除椎间盘外，同期行内窥镜下椎间自体骨植骨、cage融合术。应用Macnab标准评价临床疗效，术后每3个月复查一次X线片，采用BrantiganX线法评价椎间融合情况。结果：所有手术均顺利完成，手术时间45～110min，平均55min；出血量60～140ml，平均110ml；术中、术后均无任何并发症发生。随防6～22个月，按照Macnab标准评定，本组优25例，良4例；7例腰椎失稳患者按BrantiganX线法评价，均获得椎间融合，平均融合时间7．5个月(6～9个月)。结论：采用显微内窥镜下经椎管外椎问孑L人路手术治疗极外侧型腰椎间盘突出症具有效果良好、不进入椎管、不干扰椎管内环境、可行镜下椎间融合等优点。【关键词】腰椎间盘突H{症；显微内窥镜：手术；临床效果中图分类号：R681．5文献标识码：A文章编号：1004—406X(2008)一07—0489—05Transforaminalmicroendoscopicdiscectomyforextremelaterallumbardischerniation／Y1NHeping．WUYimin，LIShuwen，etaV／ChineseJournalofSpineandSpinalCord。2008，l8(7)：489-493【Abstract】Objective：Toreporttheclinicalexperienceandresultofthetransforaminalmicroendoscopicdis—cectomyforextremelaterallumbardischerniation．Method：FromFebruary2005toApril2007，29patientswithextremelaterallumbarherniationtreatedbytransforaminalmicroendoscopicdiscectomyandthenerverootdecompressionwereanalyzed．Disecotomywithinterbodyfusionbyautogenousbonegraftandcagewasperformedfor7casescomplicatedwithlumbarinstability．TheclinicaloutcomeswereassessedbyMacnabcri—teria．TheresultofinterbodyfusionwasestimatedbyBrantigancriteriaaccordingtotheX—raysignsincludingbonebridge，densityofthebonegraft，changeoftheheightofvertebralspace，movementscalebetweenthetwovertebralbodiesondynamicX—rayeta1．Result：A1lthecasesunderwenttheoperationsuccessfullyandwerefollowedupforaperiodof6—22months．operativetimewas45—110minutes．andthebloodlOSSwas60—140m1．Nocomplicationsoccu~ed．TheclinicaloutcomeswereassessedbyMacnabcriteria．25caseswereexcellentand4casesweregood．Thesevencasescomplicatedwithlumbarinstabilitywerefollowedupforaperiodof6-15monthsandallofthemobtainedinterbodyfusionaccordingtoBrantigancriteriaafter7．5(6-9)months．Conclusion：Thetechniqueoftransforaminalmicroendoscopicdiscectomypresentsagooddecom—pressionresult，noinvasiontothespinalcanal，lessinfluenceofthespinalstability，nodisturbanceofthein—ternalenvironmentofintervertebralcanalandtheinterbodyfusioncanbeperformedatthesametime．【Keywords】Lumbardischerniation；Microendoscopy；Operation；Clinicaleffect【AuthorSaddress】DepartmentofMinimallyInvasiveSpineSurgeryoftheSecondAfiliatedHospitalofIn—nerMongoliaMedicalCollege，Huhhot，010030，China极外侧型腰椎间盘突出症是一种特殊类型的腰椎间盘突出症，文献报道其占腰椎间盘突出症第一作者简介：男(1958一)，医学学士，主任医师，教授，硕士生导师，研究方向：微创脊柱外科电话：(0471)6351243E-mail：nmgyhp0471@126．com总数的3．8％t“。切除病变侧关节突关节、经椎间孔入路摘除髓核是传统的手术治疗方法，缺点是手术本身对脊柱结构的破坏性较大。我院2005年2月～2007年4月应用经椎管外椎间孔入路显微内窥镜...
