摘要
目的明确极外侧型腰椎间盘突出症的临床分型,为椎间孔镜手术治疗是否行椎间孔成形提供依据。方法选择2013年1月至2016年3月我科收治的52例采用经侧后方入路椎间孔镜手术治疗的极外侧型腰椎间盘突出症患者,根据椎间盘突出位置的不同将其分为Ⅰ型、Ⅱ型、Ⅲ型和Ⅳ型,按照不同手术方案分为A组(不行椎间孔成形)和B组(行椎间孔成形)。Ⅱ型患者(21例)选择A组手术方案;Ⅰ型、Ⅲ型、Ⅳ型患者(31例)选择B组手术方案。记录2组患者的手术时间、出血量、并发症发生情况,并分别于术前、术后3d、3个月及末次随访时采用腰骶部及下肢疼痛视觉模拟量表(VAS)评分和Oswestry功能障碍指数(ODI)评价功能障碍情况,末次随访时采用Macnab标准评价临床疗效。结果52例患者均顺利完成手术,未出现术后感染、术中神经根损伤、硬膜囊撕裂等严重并发症。A组患者手术时间及出血量均小于B组,差异有统计学意义(P<0.05)。所有患者随访6~24个月,平均(11±2.3)个月。术后3d、3个月和末次随访VAS腰痛、VAS腿痛和腰椎ODI评分与术前比较差异均有统计学意义(P<0.05)。末次随访Macnab疗效评定结果:优41例,良9例,可2例,优良率为94.65%。结论极外侧型腰椎间盘突出症的临床分型对认识该病的病理变化及椎间孔镜手术方式的选择具有重要的意义,临床上应根据不同的类型选择性行椎间孔成形,即Ⅱ型患者无需椎间孔成形,Ⅰ、Ⅲ、Ⅳ型患者宜选择行椎间孔成形。
Objective To provide the basis for whether the foraminoplasty should be performed or not in the treatment of percutaneous endoscopic lumbar discectomy according to the clinical classification of far lateral lumbar disc herniation. Methods From January 2013 to March 2016,52 patients with far lateral lumbar disc herniation were treated by percutaneous endoscopic lumbar discectomy via posterior lateral approach.According to the locations of the herniated disc,it can be divided into type Ⅰ,Ⅱ,Ⅲ and Ⅳ.The patients with type Ⅱ recieved the operation plan A without foraminoplasty(group A, n =21),while patients with type Ⅰ,Ⅲ and Ⅳ received the operation plan B with foraminoplasty(group B, n =31).The operation time,bleeding volume and complications of the two groups were recorded.Visual analogue scale(VAS) and Oswestry disability index(ODI) were used to evaluate the pain and dysfunction of patients before operation,3 days, 3 months after operation and the last follow-up.Macnab criteria was used to evaluate the clinical efficacy at the last follow-up. Results All 52 patients successfully received the operationwithout serious complications such as postoperative infection and intraoperative nerve root injury and tear of the dural sac.The operation time and the amount of bleeding in group A were less than those in group B,the differences were significant( P <0.05).All patients were followed up for 6 to 24 months,with an average of (11±2.3)months.VAS score of low back pain and leg pain and lumbar ODI score at 3 days,3 months and the last follow-up after operation were significantly different from those before operation( P <0.05).In the last follow-up,the Macnab efficacy score showed that 41 cases were excellent,9 cases were good and 2 cases were acceptable.The excellent and good rate was 96.15%.Conclusion The clinical classification of far lateral lumbar disc herniation is of great significance for understanding the pathological changes of the disease and the selection of surgery methods for percutaneous endosc
作者
蒲俊刚
范伟力
晁瑞
刘鹏
赵建华
PU Jun-gang;FAN Wei-li;CHAO Rui;LIU Peng;ZHAO Jian-hua(Department of Spinal Surgery,Characteristic Medical Center of Army Medical University,Chongqing 400042,China;Department of Orthopedics,Chongqing Emergency Medical Center,the Fourth People′s Hospital of Chongqing,Central Hospital of Chongqing University,Chongqing 400014,China)
出处
《局解手术学杂志》
2019年第7期553-557,共5页
Journal of Regional Anatomy and Operative Surgery
关键词
极外侧型
腰椎间盘突出症
经皮椎间孔镜手术
临床分型
椎间孔成形
far lateral
lumbar disc herniation
percutaneous endoscopic lumbar discectomy
clinical classification
foraminoplasty
