摘要
[目的]探讨经皮内镜椎板间入路椎间盘切除术微创治疗腋下型L5S1椎间盘突出症的手术技巧及临床疗效。[方法]2011年1月-2012年6月，采用经皮内镜椎板间入路椎间盘切除术（percutaneous endoscopic interlaminar discectomy，PEID）微创治疗腋下型L5S1椎间盘突出症32例。其中男18例、女14例；年龄13～53岁，平均33．5岁。采用疼痛视觉模拟评分（visual analogue scale，VAS）、Oswestry功能障碍指数（oswestry disability index，ODI）、改良MacNab评价临床疗效。[结果]本组病人均获得随访，随访时间12～20个月，平均15．5个月。平均手术时间（61．4±12．6）min。术中平均透视时间（0．5±0．3）S。32例患者术后腰腿痛、感觉肌力减退均有不同程度的好转。术前，术后1d，术后1、3、6、12个月腰痛VAS评分分别为（6．00±1．46），（3．81±0．75），（1．88±1．15），（0．81±1．05），（0．63±0．62），（0．25±0．45）；腿痛VAS评分分别为：（7．88±0．81），（2．88±1．45），（2．13±1．02），（1．38±0．62），（0．88±0．62），（0．81±0．54）。术前、术后1、3、6、12个月ODI评分分别为（47．63±9．91），（38．4±10．46），（26．75±6．88），（13．81±5．95），（9．19±6．04）。术前与术后多时段腰腿痛评分及ODI评分差异有统计学意义（P〈0．01）。术后12个月时用改良MacNab评价疗效，优良率90．6％。[结论]经皮内镜椎板间人路椎间盘切除术微创治疗腋下型L5S1椎间盘突出症具有创伤小，出血少，术中透视少，暴露清楚，便于保护神经结构，减压彻底，术后恢复快等优点，其近期疗效确切，远期结果有待进一步随访。
[ Objective] To evaluate the surgical techniques and clinical efficacy of percutaneous endoscopic interlaminar discectomy （PEID） in treatment of axillary herniation at L5S1. [ Methods] Thirty -two patients with axillary herniation at L5S1 were treated by PEID from January 2011 to June 2012. Among them, 18 were male and 14 were female. The age ranged from 13 to 53 years with an average age of 33.5 years. Visual Analogue Scale （ VAS ） , Oswestry Disability Index （ ODI ） , modified MacNab criteria were used for clinical efficacy evaluation. [ Results] All the patients were followed up for a mean period of 15.5 months （range, 12 -20 months） . The mean operation time was （61.4± 12. 6） min. The average intraoperative fluoros- copy time was （ 0. 5 ±0. 3 ） s. Sensory disturbance , muscle weakness, leg pain and low back pain were relieved in all patients. The VAS scores of back pain were （6.00±1.46）, （3.81±0.75）, （1.88±1.15）, （0.81±1.05）, （0.63± 0. 62）, （0. 25±0. 45） preoperatively and 1 day, 1 month, 3 months, 6 months and 12 months postoperatively. The VAS scores of leg pain were（7.88±0.81）, （2.88±1.45）, （2.13±1.02）, （1.38±0.62）, （0.88±0.62）, （0.81±0.54） incorresponding follow - up time. The ODI scores were （ 47. 63 ± 9. 91） , （38.4±10.46）, （26.75±6.88）, （13.81±5.95）, （9. 19 ± 6.04） preoperatively and 1 month, 3 months, 6 months and 12 months postoperatively. Back and leg pain VAS scores, ODI were statistically different between preoperative time and corresponding follow - up time. The excellent and good results rate of modified MaeNab criteria at the last follow - up was 90. 6%. [ Conclusion] Percutaneous endoscopic interlaminar diseeetomy is a safe, effective and minimally invasive procedure on axillary herniation at L5S1, with the advantages of less intraoperative fluoroscopy, clear exposure, complete decompression and quick recovery with satisfactory short -term results, while its long - term results requir
出处
《中国矫形外科杂志》
CAS
CSCD
北大核心
2014年第13期1169-1175,共7页
Orthopedic Journal of China
基金
卫生部行业科研专项基金(编号:201002018)
关键词
椎间盘移位
腰椎
微创外科手术
经皮内镜腰椎间盘切除术
椎板间入路
intervertebral disk displacement, lumbar vertebrae, minimally invasive surgery, percutaneous endoscopic lumbar discectomy, interlaminar approach
