摘要
目的：探讨改良的同轴脊柱内镜操作系统（YESS）技术在治疗腰椎间盘突出症中应用的技术要点与中期临床疗效。方法回顾性分析2009年1月—2010年1月解放军总医院骨科单个医生连续收治的134例腰椎间盘突出症患者的临床和随访资料,其中男93例,女41例,年龄14~84岁。局部麻醉下,应用改良的 YESS 技术行椎间盘摘除术,采用后外斜入路96例,椎板间孔入路38例。通过对比术前与术后疼痛视觉模拟评分（VAS）,应用 MacNab 评分对患者中期疗效进行评估。结果术中有2例患者出现心悸、出汗等症状,给予补液支持治疗后缓解,并完成手术。134例患者手术全部顺利完成,术后均获得随访,随诊时间平均（69.5±3.0）个月。内镜术后开放返修3例,返修率2.23%（3/134）。术前 VAS 中位数为8（7,9）分,术后即刻为1（1,2）分,术后6个月为1（0,1）分,术后1年为1（0,1）分,术后5年为1（0,1）分,术前与术后5年 VAS 差异有统计学意义（Z =-10.082, P 〈0.01）。末次随访 MacNab 评分,优108例,良17例,可6例,差3例,优良率为93.3%（125/134）。结论应用改良 YESS 技术治疗腰椎间盘突出症临床效果较好,因其手术技术简便、手术时间短、患者耐受程度高,从而有利于该手术的推广和实施。
Objective To evaluate the key techniques of modified Yeung endoscopic spine system （YESS） and analyze clinical effects of medium-term for lumber disc herniation （LDH）. Methods From January 1st, 2009 to January 1st, 2010, 134 patients （93 males, 41 females, aged from 14 to 84） with LDH received operation with modified YESS in PLA General Hospital. Ninety-six of them were treated posterallaterally and 38 were operated from vertebral plate. The clinical effects of the operations were eraluated through comparing the VAS and the follow-up MacNab scores. Results During the operation, 2 patients had symptoms such as palpitations, sweating, alleviate after rehydration support treatment, and the operation was completed. One hundred and thirty-four patients were followed up with an average period of （69. 5 ± 3. 0） months. There were 3 repair cases after the percutaneous endoscopic lumbar discectomy operation with a ratio of 2. 23% （3 / 134）. The comparison of the VAS score had a significant difference （Z = - 10. 082, P 〈 0. 01）. According to Macnab scores, the results were excellent in 108 patients, good in 17 patients, fair in 6 patients and poor in 3 patients, the excellent and good rate was 93. 3% （125 / 134）. Conclusions Modified YESS has reached excellent clinical effects for LDH. It is also helpful for promoting percutaneous endoscopic lumbar discectomy with its more succinctly surgical technic,shorter operation time and better tolerance of patients.
出处
《中华解剖与临床杂志》
2015年第6期499-503,共5页
Chinese Journal of Anatomy and Clinics
关键词
椎间盘移位
腰椎
外科手术
微创性
内窥镜
Intervertebral disc displacement
Lumbar vertebrae
Surgical procedures,minimally invasive
Endoscopes
