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1998年9月から2003年12月までに腰椎椎間板ヘルニアに対して後方進入内視鏡視下手術(MED)を施行した402症例を対象として,手術成績,その適応と問題点を検討した.男性262例,女性140例,平均年齢37.9±14.9歳であった.疾患の内訳は腰椎椎間板ヘルニア386例,椎体後方終板障害16例であった.腰椎椎間板ヘルニアは手術時平均年齢38.5±14.6歳,術前平均JOAスコア13.4±5.1が術後26.3±3.1,最終調査時27.6±2.2,平均手術時間70.9分,出血量35.7mlであった.椎体後方終板障害は平均年齢21.6±13.9歳,JOAスコア16.9±3.6が術後27.1±2.3,最終調査時28.2±1.6,手術時間95.3分,出血量67.5ml,周術期の合併症は合計16例4.0%に認められた.内訳は硬膜損傷6例,部位の誤認3例,術後血腫による悪化4例,化膿性脊椎炎1例,一過性の筋力低下2例であった.再手術が12例に行われ,ヘルニア再発9例,術後血腫2例,除圧不足1例であった.腰椎椎間板ヘルニアに対する後方進入脊椎内視鏡視下手術の適応は椎間板高位にあるヘルニアのみならずmigrateしたヘルニア,中心性ヘルニア,椎体後方終板障害に加えて最外側ヘルニアにも従来法にはない利点があり,手術手技に熟練すれば安全で良好な成績が期待できる.
Microendocopic discectomy was performed for lumbar disc herniatoin in 402 consecutive patients between September 1998 and December 2003. There were 262 men and 140 women, and the patients' average age was 37.9±14.9. There were 386 cases of lumbar disc herniation, and 16 cases of posterior endoplate lesions. The surgical outcomes showed an improvement in JOA score for lumbar disc herniation from 13.4±5.1 to 26.3±3.1 postoperatively;moving to 27.6±2.2 in the final follow up. Complications occurred in 16 cases (4.0%). Specifically, there were dural tears, (6 cases), misjudgment of the operative site, (3 cases), post-operative hematoma, (4 cases), pyogenic osteomyelitis, (1 case), and transient motor weakness, (2 cases). The re-operation rate was 3%, 12 cases. These consisted of recurrence of disc herniation (9 cases), postoperative hematoma (2 cases) and insufficient decompression (1 case). MED affords not only less invasive surgery, but also offers the advantages of endoscopic surgery. Therefore, MED can be indicated for all types of lumbar disc herniation and may produce good clinical outcomes, if sufficient endoscopic surgical skill is attained.
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