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1、内窥镜下经横突间入路治疗椎间孔外型腰椎间盘突出症周跃王建张峡王卫东初同伟李长青张正丰郑文杰（第三军医大学新桥戻院骨科，重庆市400037）摘要：【目的）探讨经横突问入路Metrx内窥镜下椎间孔外型腰椎间盘突出髓核摘除、神经根减压松解的手术技术、临床效果及适应证选择。【方法】俯卧位，棘突屮线旁开2.5cm〜3.Oem作一个1・6cm纵行皮肤切口。工作导管置于横突间，由浅人深逐渐分离显露横突间韧带，锐性剥离横突间韧带，找到神经根将其向外侧牵开，显露突出椎间盘并予以摘除。（结果】本组9例，男7例、女2例。平均46.7岁。平均手术时间75分钟，
2、平均术中出血60ml,平均住院时间13天，全组手术切口均一期愈合。随访时间6月到16个月。疗效评定按Nakai分级，优6例，良2,可1例。〔结论）虽然该术式对医生的解剖知识和腔镜下“手跟分离”的操作能力要求较高，但创伤小，手术视野清楚，操作精细,能达到优良的术后效果，是治疗椎问孔外型腰椎间盘突出症的一种可供选择的新术式。关键词：椎间孔外型腰椎间盘突出；腰椎间盘切除术；内窥镜（Metrx）D•1scectomy0feXtraforamina11umbardischerniati0nthrought:heinfratransversePro
3、cessesbyendoscoPeZH0UYueoWANGJ•1an,ZHANGXia，etalDePartmentof0rzhopaedics,X1nQia.oHospita1,ThirdMi1itaryMedica1university,(kn鲫•119400037Abstract:(0bJective)Todiscussthesurg•1ca1skill,c1inica1effectsandindieat•10nsofdiscectomyandnervrootdecompressionandbrisement0ftheextraf
4、oram■1na11umbar（diseherniationthroughthein-—fratrainSVersepr0cessesbyendosc0pe.(Meth0dWiththePatientsinproneP■osition,aVertica1skininci.sion1■6cmin1engthand2、5—-3.0cmindistance1atera1t0t；hespinalProcessesWaSse1ected.Thew0rkingca:na1wasputintotheinfratransverseprocesses.W
5、iththe1ntertransverse1igamentgradua11yexp0sedanddissected,andthenerverootf0undandpu11ed1atera11y,,theherniatedintervertebra1discwasexposedaadreseeted.(Resu1t)A119eases(46.7yearso1dinaverage)including7malesand,2fe.malesfollowedupfrom6to16months.Theiraverageoperatingtimewa
6、s75minutes,averagebleed—ingvolumeduringoperationwas60mlandaveragehospita1■1zat•1ontimewas13days.0perative■1nc•1■s•10nS0fa11casesobtainedprimar〔yhea11ng.Acordingt0Nakaistandard,6eaSesscoredexcellen.t1eve1•2goodan（d1•1mpr0Vement・(Conc1usion)A1thoughthis0perationa1methodreq
7、uiresthedoctor0fass0.e1atedanatomica1know1edgeandsurgica1ski11inoperationbyend0sc0pebecause0fminima1injury,c1earand131reciseof0perativescopeandexce11entcurativeeffectitisavailab1eforch01cetothetheraDvofextraforamina11umbardischerniation.一1S2—Keyw0rds■•EXtraforamina11umba
8、rdischerniation■9D■1scectomy；Endoscope传统术式治疗极外侧型腰椎间盘突岀症经后侧腰椎板间隙入路、椎问孔扩大和关节突切除完成。鉴于传统术式对脊椎后部结构的破坏较大，从而对脊
