1、321 S1997 M517 5 田世杰 王进军 刘德隆 黄 辉 杨 煦 苏庆军经皮椎间盘镜腰椎间盘摘除术K11992 M1 1996 M6 W W %W K“ (AMD) %W l268 ,377Q m 。 191 , (2.5 M, q82.2%。 y:W |M,1lgv9 3 T u$, ?, *5(6 .4mm)s。 PW b A U , j4h ui V*5h * 。30 C8% * 4# :L 2 、L3 、L4 *KD44.42.21,L5 * 35.42.31。(: , )#,O m ,9FK“v v|MW , Ph s,4lh r。F,O m 54 ,O m 78 , q76
2、%。MRI_h : 1oT。%W l ?4 ,O ZE %y 。Fi? ,* ? 3 *BV 2 , 2。,O T51。1oM%W l ,OW 1Percutaneous Discoscopic Lumbar Discectomy Tian Shijie, WangJinjun, LiuDelong , et al.DepartmentofOrthopedics, Beijing Red_Cross Chao Yang Hospital, Capital University of Medicine,Beijing 100020Abstract 337 percutaneous arthros
3、copic micrediscectomies in 268 patients were performed between 1992and 1996.There were 191 cases availble for folow_up.82.2%of the patients obtained excellent and good resultswith an average of 2.5 years follow_up.The authors emphasize that the operation should be performed in the proneposition and
4、the puncture failure may be due to serious regression of the disc , hypertrophy and hyperplasia of thearticular process and high developed ilium.Discoscope can clearly reveal the local anatomic structure and protectthe nerve root from injury under direct vision.Examination and measurement of 30 adul
5、t corpses showed that theoptimal puncture angle was 44.42.21 in L 2 ,L 3 and L 4 , 35.42 .31 in L 5 .Fitty_four prolaspsed (withoutrift of posterior longitudinal ligament)and 78 central typed herniation in this series were punctured from bothsides and obtained an excellent and good rate of 76%.MRI i
6、s a valuable method to determine the intact of the pos-terior longitudinal ligament.Only two early cases had temporary partial injury to nerve root because misinserting ,and all of them recoverd 2 months later.Key words Lumbar disc protrusion Percutaneous Discoscopic ;1993 M1 W (AMD“d)%W K“ (arthosc
7、opic mi-crodiscectomy , AMD)1 。1992 M1 1996 M6 W 268 ,377Q m , T。,O y,W / n,# m , i?5) 。“5 268 , #h ,O130 , ,O2 ,O109 , AMD 377Q。 3167 , o101 。 M -20 70, (40.6 。6 h , RE!。377Qm s:L 4 -5 , 249Q;L 5 S1 , 86Q;L 5 -6( %, h B1 ,V ,O T A1L 5S 1M1 T ,#L 5 -6d9),22Q, L 3 -4 , 17Q;L 1 -2 , 3Q。 q94.1%(355/377
8、)。 191 , HW1 4.5 M, (2.5 M,TMacnab S N:117 (61.2%), 44 (21%),10 (5.2%),24 (12.5%), q82.2%。 24 (12.5%),sY# %W K“ ( 7b)。T:100020 nD Sv E3D S(B W、 +、 H、 i +); u D S()322 Chin J Orthop, May 1997, Vol.17, No.5m 8 ,O%W K“ PLD 2 , 3 ,AMD 4 , 5 ,APLD68 |。F m 。:(1)W lh -lM8。(2) y w V H/e。(3)W#9 z,L 、,O、5#b*5
9、% 。(4) m x T, ,O H T V H。(5)9F m , Onik; ,O m H1Z? 3,5 W L=? 3M, / *、 -v5、 8# ,i 5。(6)LCT/ ,O,4# q, “ - X 7 S PCT/ T。) B、,O yF268 , 377Q,O, 22Q ,q94.1%(355/377)。 L 4 5 , 96.3%(240/249)、L5S 1 , 87.2%(75/86)、L 5 6 , 95.4%(21/22)、L3 4 , 94.1%(16/17)、L1 2 , 100%(3/3),O AMD、APLD、PLD %W l1oB,?,Oo 、/、% 、s、
10、%Z,/8l 、 1l Tu(triangualar working zone),/8 W r s,OV E *, V/,O 。F 22 (5.8%)。sF,O y:(1)%|M, f /1l T u, */8 C$,1l9 3gv H PC$ v,O 5 。(2)W |M、.N、 T uHM , *W , ,O,5(6.4 mm) H?E 7 *4 。(3) ?, 31o A, K tWCl, PL5S1 ,O9F 4,10 。(4) * H,. W %W K“(). S, 1993, 13:3.2 Hijikata S.Percutaneous nuceotomy A new coneep
11、t techniqueand 12 yrsexperience.Clin Orthop, 1989, 238:9.3 Kambin P, Schaffer JL.Percatineous lumbar discectomy.Review of 100Patients and current parctice.Clin Orthop,1989, 278:24.4 Sehaffer JL, Kambin P.Percutaneous postroleral lumbar dis-cectomyand disconpression with a 6.9mm.Cannala.J BoneJoint s
12、urg(Am), 1991, 73:822.5 Kambin P.Posterolateral percutaneous lumbar discectomy anddicompression:Arthrocopic Microdiscectomy.minimal inter-vention in spinl surg.Baltimore, urban and Schwarzenberg,1991.67.6 Onik G , Helms CA, Ginsburg L.Percutaneous lumbar discec.Am J R, 1991, 156:531.7 Grenier N, Gre
13、selle JF, Vital JM , et al.Normal and disrupedlumbar longitudinal ligaments correlative MR and auatomicstudy.Radiology.1989, 171:197.8 Schreiber A, Saejawa Y, Hansjoerg L.Does percutaneous nu-cleotomy discectomy?Eight years of experience and result intreatment of herniated lunbar dise.Clin Orthop, 1
14、989, 238:35.9 Blankenstein A , Rubinstein E, Ejra E, et al.Disc space in-fection and Vertebral Osteomyelitis as a complication of per-cutaneous lumbardiscectomy.Clin Orthop, 1987, 225:24.10 Monteiro A, Lefver R, Pieter G , et al.Lateral decompressionof a pathological dsic in the of lumbar pain and s
15、ciafica, ClinOrthop, 1989, 236:56.( l:1996-10-03)v v|MW sXvs FM F, *# 5, 7b m H9 V | S,/X F,7 M F。K“ v v|MW V sh, V ? PlW ,s , irT。F130 AMD41QK“ v v F, Kv 4.5 g。、 AMD T1(B),O、 B。(=) 731| v*5(6.4 mm)MB,W /A U 73 gY,Lv v|MW FYV*5K“。( ) *5YVW MY, V P W =M(, m /K“W ,rW = sh,B !, !AYV*5 W =,YV*5_ 。( )K“W
16、 ,+ ,#_ 、_ ,V *5 =xK“, dW F, P *# 5 sh。Hijikata21 PLDrT ih , W /A UV M“ -W F,=Q m M“W F | irT。ShepperdK“W F q63%,+. ,K“W F, q 679%。 K“W F1。B、 i?PLD(AMD,APLD) i? n。D 2 5, 7 9 *、5(%) ,1? 3L5S1m ,5 ,%,W (W 、8 )。F268 , 377QAMD? 32 * , F* h ,2 y T, Z T,O#*5O #* 。 o sY 23, 3 M#2 M9 T (。Z T#*5 H, * Hh ?*tC a、 n,KCe, * -Bx, T#5, m T,9 ,O m 。Hijikata 2 05mm *5,yih ( P5mm *5;4mm*5 5 。Monteiro10 ,Schaffer4 ,Schreiber8,sY P5.5 , 6.9 ,7.2 mm,5# * ? 3 A9F。FAMD*56.4 mm,5(6.4 mm)V F377Q m B? 35# ,9? 3%。 * ,O T1。 P Y*5(6.4 mm), T?, W P 5 ,P vv/, H9FK“vv|MW F, V4 m rT。 ID
