摘要
目的探讨单边双通道内镜技术治疗脱出游离型腰椎间盘突出症的疗效。方法回顾性分析2018年7月~2019年8月单边双通道内镜下椎板开窗椎间盘髓核摘除术治疗31例脱出游离型腰椎间盘突出症的资料。MRI判断髄核来自L2/31例,L3/41例,L4/55例,L5/S124例。25例髄核向尾侧脱出,6例向头侧脱出(其中3例游离至头侧椎弓根水平,1例游离至椎间孔内)。术前、术后1个月、3个月及末次随访时进行腰腿痛视觉模拟量表(Visual Analogue Scale,VAS)评分和Oswestry功能障碍指数(Oswestry Disability Index,ODI)评估,改良MacNab标准评价疗效。结果31例手术均顺利完成,手术时间44~79 min,(65.2±7.8)min。术中硬膜囊撕裂1例。随访3~12个月,(6.4±2.9)月。术前腰腿痛VAS评分(5.9±0.7)分,术后1、3个月及末次随访时分别下降至(2.4±0.7)分、(1.2±0.6)分、(0.6±0.5)分(F=653.970,P=0.000)。术前ODI(53.1±6.5)%,术后1、3个月及末次随访时分别下降至(28.6±4.6)%、(15.2±2.4)%、(11.3±3.6)%(F=856.115,P=0.000)。末次随访时改良MacNab标准优25例,良4例,可1例,差1例,优良率93.5%(29/31)。结论单边双通道内镜技术镜下视野清晰开阔,操作空间大,可用于治疗脱出游离型腰椎间盘突出症。
Objective To investigate the clinical efficacy of unilateral biportal endoscopy in the treatment of prolapse type lumbar disc herniation.Methods A total of 31 cases of prolapse type lumbar disc herniation treated by unilateral biportal endoscopic discectomy from July 2018 to August 2019 were retrospectively analyzed.According to the MRI,the prolapsed pulposus nucleus herniated from L2/3 in 1 case,L3/4 in 1 case,L4/5 in 5 cases,and L5/S1 in 24 cases.The direction of herniation was caudal in 25 cases and cephalic in 6 cases.The clinical efficacy was evaluated by the Visual Analogue Scale(VAS),Oswestry Disability Index(ODI)and modified MacNab scale at preoperative,postoperative 1,3,6 months and the last follow-up.Results The operation procedure was successful in all the 31 patients.The operation time was 44-79 min,with an average of(65.2±7.8)min.Complications included dural sac tears in 1 case.All the patients were followed up for 3-12 months,with an average of(6.4±2.9)months.Preoperative VAS scores were(5.9±0.7)and respectively decreased to(2.4±0.7),(1.2±0.6),and(0.6±0.5)at postoperative 1,3 months and the last follow-up,and the difference was statistically significant(F=653.970,P=0.000).Preoperative ODI was(53.1±6.5)%and decreased to(28.6±4.6)%,(15.2±2.4)%,and(11.3±3.6)%at postoperative 1,3 months and the last follow-up,and the difference was statistically significant(F=856.115,P=0.000).According to the modified Macnab criteria,the final outcome was excellent in 25 cases,good in 4 cases,fair in 1 case,poor in 1 case at the final follow-up,with an excellent-or-good rate of 93.5%(29/31).Conclusion Unilateral biportal endoscopy has advantages of clear vision and large operating space and is a good endoscopic option for the treatment of prolapse type lumbar disc herniation.
作者
田大胜
朱斌
刘建军
陈磊
王其飞
荆珏华
Tian Dasheng;Zhu Bin;Liu Jianjun;Jing Juehua(Department of Orthopaedics, Second Hospital of Anhui Medical University, Hefei 230601,China)
出处
《中国微创外科杂志》
CSCD
北大核心
2020年第12期1083-1087,共5页
Chinese Journal of Minimally Invasive Surgery
基金
安徽省高校自然科学研究重点项目(KJ2019A0257)。
