腰椎椎間板ヘルニアに対するmicroendoscopic discectomyの手術成績と合併症について

Clinical Outcome and Complications of Microendoscopic Discectomy for Lumbar Disc Herniation

　2002年7月から2004年9月までにMED法を行った40例を対象に，手術時間，JOAスコア，術後鎮痛剤使用の有無，在院日数，合併症・再発の有無を調査検討した．手術時間は平均97.0分を要したが，JOAスコアの改善率は93.7％と良好であり，術後鎮痛剤使用率は22.5％と少なく，在院日数も5.4日と短かった．合併症は初期に硬膜損傷とヘルニアの早期再発を，後期に多量出血を認めた．MED法は低侵襲で良好な手術成績を上げることができるが，技術レベルに応じた合併症の存在に注意すべきである．

　We performed microendoscopic disectomies (MEDs) in 40 patients with lumbar disc herniation between July 2002 and September 2004. Here, we retrospectively investigated the operation time, JOA score, postoperative use of NSAIDs, complications, and the early recurrence of disc herniation. The mean operation time was 97.0minutes, the mean improvement in the JOA score was 93.7％, the percentage of NSAIDs use was 22.5％, and the mean hospital stay was 5.4 days. Dura mater injury and the early recurrence of disc herniation were observed as early complications, while large hemorrhage was observed as a late complication. MED is a minimally invasive and effective procedure, but the occurrence of complications according to the surgeon's level of skill should be considered.