摘要：

目的 探讨METRx 系统辅助下腰椎间盘突出症显微外科手术的技术特点和临床疗效。方法 于METRx 系统辅助下显微外科手术治疗51 例腰椎间盘突出症患者（L_4-5 椎间盘突出24 例、L₅-S₁椎间盘突出27 例），记录手术时间、术中出血量和住院时间，并于术前和术后1 周、3 个月、末次随访时采用视觉模拟评分（VAS）和Oswestry 功能障碍指数（ODI）评价手术前后疼痛改善情况，复查腰椎MRI评价椎管减压程度。结果 51例患者手术成功率为98.04%（50/51），平均手术时间为125 min、术中出血量为50 ml、住院时间5 d、术后随访24 个月。与术前相比，术后1 周（P = 0.036，0.029）、3 个月（P = 0.018，0.023）和末次随访时（P = 0.007，0.013）VAS 和ODI 评分均减少；至末次随访时，ODI 改善率为35.37%。无手术相关感染、术后脑脊液漏和神经功能缺损加重、手术切口感染病例。术后1 例出现附件炎，1 例神经根刺激症状明显，均经对症治疗后痊愈。结论 METRx 系统辅助下显微外科手术治疗腰椎间盘突出症，可以有效解除神经根压迫、保护硬脊膜囊和神经根、减少手术并发症的发生。

关键词: 椎间盘移位, 腰椎, 显微外科手术, 外科手术, 微创性

Abstract:

Objective  To explore the techniques and curative effect of microsurgical procedures assisted by minimal exposure tubular retractor system (METRx) in the treatment of lumbar disc herniation (LDH).  Methods  A total of 51 LDH patients, including 24 patients with L_4-5 herniation and 27 patients with L₅-S₁ herniation, underwent discectomy assisted by METRx system. The operation time, intraoperative blood loss, postoperative complications and hospital stay were recorded. Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI) were used to evaluate the degree of low back pain before operation, one week, 3 months after operation, and in the last follow-up. Lumbar MRI was used to evaluate the decompression of spinal canal.  Results  The success rate of operations in 51 cases was 98.04% (50/51). The average operation time was 125 min, the average intraoperative blood loss was 50 ml, the mean hospital stay was 5 d, all patients were followed up for 6-48 months (average 24 months). Compared with preoperation, both VAS and ODI scores decreased significantly one week after operation (P = 0.036, 0.029), 3 months after operation (P = 0.018, 0.023) and in the last follow-up (P = 0.007, 0.013). The improvement rate of ODI was 35.37% in the last follow-up. No infection, postoperative cerebrospinal fluid (CSF) fistula, neurological defects or incision infection was found. One patient presented acute abdominalgia on the 2nd day after operation, and was diagnosed as annexitis. One patient showed nerve root irritation symptoms after operation caused by thick nerve root during the surgery. They were cured after symptomatic treatment.  Conclusions  Microsurgical procedures for treating LDH assisted by METRx system can effectively relieve nerve root compression, protect the dural sac and nerve roots, and reduce surgical complications.

Key words: Lumbar disk displacement,  Lumbar vertebrae, Microsurgery, Surgical procedures, minimally invasive