摘要
目的评价椎间孔镜TESSYS技术治疗腰椎间盘突出症合并Ⅰ°稳定型腰椎滑脱症的效果。方法腰椎间盘突出症患者32例，年龄51～82岁，体重52～93 kg，ASA分级Ⅰ或Ⅱ级，按照是否合并腰椎体滑脱分为2组（n＝16）：腰椎间盘突出症组（Y组）和腰椎间盘突出症合并Ⅰ°稳定型腰椎体滑脱症组（Y＋Z组）。在椎间孔镜下2组进行突出物摘除、黄韧带及后纵韧带成型、神经根松解减压术，然后Y＋Z组切除增生的骨质和后移的椎体后缘。于术前1 d和术后3 d、1、3、6、12个月时采用视觉模拟评分法（VAS）评价疼痛程度；分别于术前1 d和术后12个月时采用Oswestry功能障碍指数评定患者功能情况；术后12个月时采用Macnab分级评价疗效。结果与术前1 d时比较，2组术后各时点VAS评分降低，术后12个月时Oswestry功能障碍指数降低（P〈0.05）；与Y组比较，Y＋Z组术后3和6个月时VAS评分升高（P〈0.05），各时点Oswestry功能障碍指数、术后12个月时VAS评分和Macnab分级差异无统计学意义（P〉0.05）。结论椎间孔镜TESSYS技术可用于腰椎间盘突出症合并Ⅰ°稳定型腰椎滑脱症患者的治疗。
Objective To evaluate the efficacy of transforanminal endoscopic spine system（TESSYS）technique in treating lumbar disc herniation complicated with Ⅰ degree stability of lumbar spondylolisthesis.Methods Thirty-two patients with lumbar disc herniation, aged 51-82 yr, weighing 52-93 kg, of American Society of Anesthesiologists physical statusⅠ or Ⅱ, were randomly divided into 2 groups（n=16 each）according to whether patients had lumbar spondylolisthesis： lumbar disc herniation group（Y group）and lumbar disc herniation combined with I degree stability of lumbar spondylolisthesis group（Y＋ Z group）. Extirpated protrusion, plasty ligamenum flavum and posterior longitudinal ligament and nerve root decompression were carried out using TESSYS technique in two groups, and in addition excision of osseous neoplasias and retro-positioned posterior margin of lumbar vertebral body was done in group Y＋ Z.Pain was assessed using Visual Analogue Scale（VAS）score at 1 day before surgery and 3 days and 1, 3, 6 and 12 months after surgery.Patient′s function was assessed by using the Oswestry Disability Index（ODI）at 1 day before surgery and 12 months after surgery.The therapeutic effect was evaluated using modified Macnab criteria at 12 months after surgery.Results Compared with the baseline at 1 day before surgery, VAS scores were significantly decreased at each time point after surgery, and ODI was decreased at 12 months after surgery in two groups（P〈0.05）. Compared with group Y, VAS scores were significantly decreased at 3 and 6 months after surgery（P〈0.05）, and no significant change was found in ODI at each time point or VAS scores and Macnab outcome grade at 12 months after surgery in group Y＋ Z（P〉0.05）.Conclusion TESSYS technique can be used to treat lumbar disc herniation complicated with Ⅰ degree stability of lumbar spondylolisthesis.
作者
栾静
贺永进
王琦
王准
郑伟
张景卫
魏成博
Luan Jing;He Yongjin;Waag Qi;Wang Zhan;Zheng Wei;Zhang Jiagwei;Wei Chengbo(Department of Pain Management, First Center Hospital, Tianjing 300211, China;Department of Anesthesiology, First Center Hospital, Tianjing 300211, China)
出处
《中华麻醉学杂志》
CSCD
北大核心
2017年第12期1438-1441,共4页
Chinese Journal of Anesthesiology
关键词
椎间盘移位
内窥镜
外科手术
微创性
Intervertebral disk displacement
Endoscopes
Surgery, minimally invasive
