外側型腰椎椎間板ヘルニアに対するMETRx systemを用いたmicrodiscectomy

Microdiscectomy Using the METRx System for Lateral Lumbar Disc Herniation

　抄録：外側型腰椎椎間板ヘルニアに対しMETRx microdiscectomy systemを用いて後外側アプローチからヘルニア摘出を行った12症例の臨床成績を調査し，本術式の有用性について検討した．結果は全例で18mmの皮切にてヘルニア塊を摘出することができた．手術時間は平均1時間48分であり，術中出血量は全例50ml以下と微量であった．全例にて術直後から著明な症状の改善が得られ，JOAスコアは術前平均12.9点が最終経過観察時（平均1年4カ月）では平均26.2点に明らかに改善し，改善率は平均81.7％と良好な結果が得られた．以上より本術式は低侵襲で良好な臨床結果が得られる非常に有用な術式と結論した．

　The goal of this study was to assess the usefulness and invasiveness of the microscopic tubular retractor system (METRx-MD) for the treatment of lateral lumbar disc herniation. Twelve consecutive patients with lateral lumbar disc herniation underwent surgery via a posterolateral approach using METRx-MD instrumentation with a small skin incision (18mm). Every surgical procedure was performed by the same surgeon. The mean follow-up period was 16months (range, 7-28months). At the end of the follow-up period the outcome of surgery were evaluated based on the Japanese Orthopaedic Association (JOA) score. All procedures were completed using this technique. No intraoperative or early postoperative complications were noted. The mean operation time was 108minutes (range, 60-120min), and blood loss was less than 50mlin every case. The average recovery rate based on the JOA scores was 81.7％. The METRx-MD-based procedure combines the advantages of a three-dimensional visual field under a microscope and the minimal surgical invasiveness of endoscopic procedures. Thus, METRx-MD enables successful minimally invasive surgery via a posterolateral approach in patients with lateral lumbar disc herniation