摘要
目的探讨经皮椎间孔镜下椎间盘摘除术(PELD)治疗单节段脱垂型腰椎间盘突出症的临床疗效。方法回顾性分析2018年1月—2019年3月南京医科大学附属无锡市人民医院40例单节段脱出游离型腰椎间盘突出症患者的临床资料。其中男22例,女18例;年龄18~52岁,平均32岁。病变节段:L3/4 4例,L4/5 29例,L5/S1 7例。腰椎间盘突出的严重程度按照Lee分型标准,Ⅰ型3例,Ⅱ型7例,Ⅲ型21例,Ⅳ型9例。40例患者均接受PELD ,其中采用椎间孔侧入路34例,椎板间入路6例。观察患者术后恢复情况和并发症发生情况,比较患者术前及术后第1天、1个月及6个月的疼痛视觉模拟评分(VAS) 、Oswestry功能障碍指数(ODI)。术后6个月复查MRI了解有无髓核再脱出情况,并采用MacNab标准评定疗效。结果患者均顺利完成手术,手术时间45.9~72.0(59.8±12.5)min,术中出血量均<18 mL。术后椎间孔侧入路手术患者出现椎间隙感染1例,椎板间入路手术患者出现症状残留1例。40例患者均获随访,随访时间6~12(8.2±2.7)个月。术后第1天、1个月、6个月疼痛VAS评分分别为(2.3±0.7)、(0.8±0.3)、(0.3±0.1)分,ODI分别为21.3%±3.4%、11.9%±2.9%、3.1%±1.5%,均低于较术前的(7.2±1.3)分、62.8%±5.5%,差异均有统计学意义(F=10.812、8.750,P值均<0.05)。术后6个月复查MRI,1例椎板间入路手术患者存在脱出髓核残留,其余患者均未见髓核残留及复发。术后6个月按MacNab标准评定疗效,优36例、良2例、可2例,优良率为95.0%。结论 PELD治疗单节段脱垂型腰椎间盘突出症临床疗效满意,但头、尾端高度脱垂移位的患者对手术者来说仍是一项挑战。
Objective To observe the clinical efficacy,surgical techniques,and complications of percutaneous endoscopic lumbar discectomy(PELD)in the treatment of lumbar disc herniation with single-segment prolapse.Methods The clinical data of 40 patients(including 22 males and 18 females,aged 18-52 years old,with an average age of 32 years)with single-segment prolapse and free lumbar disc herniation from January 2018 to March 2019 in Wuxi People's Hospital affiliated to Nanjing Medical University were retrospectively analyzed.The diseased segment included L3/4(4 cases),L4/5(29 cases),and L5/S1(7 cases).According to the Lee classification criteria,the severity of lumbar disc herniation was typeⅠin 3 cases,typeⅡin 7 cases,typeⅢin 21 cases,and typeⅣin 9 cases.All 40 patients were treated with PELD,34 and 6 of which underwent the foraminal approach and interlaminar approach,respectively.The patients'postoperative recovery and complications were observed,and patients'visual analogue scale(VAS)and Oswestry disability index(ODI)were compared before operation and 1 day,1 month,and 6 months after operation.At 6 months after the operation,the MRI was reviewed to determine whether the nucleus pulposus relapsed.The MacNab standard was used to evaluate the efficacy at 6 months after surgery.Results The operation was successfully conducted in all patients.The operation time was 45.9-72.0(59.8±12.5)min.The intraoperative blood loss of all patients was less than 18 mL.One case of intervertebral space infection occurred in a postoperative patient with the foraminal approach,and one patient had residual symptoms after an interlaminar approach.All 40 patients were followed up after surgery.The follow-up time was 6-12(8.2±2.7)months.The VAS scores were(2.3±0.7),(0.8±0.3),and(0.3±0.1)1 day,1 month,and 6 months after surgery,and the ODI was 21.3%±3.4%,11.9%±2.9%,and 3.1%±1.5%,respectively,which were all lower than the preoperative values(7.2±1.3)and(62.8%±5.5%).The difference was statistically significant(F=10.812,8.750,all P v
作者
陆彬彬
高爱国
金祺
周颖川
王烨
张钦
李丁
顾晓峰
Lu Binbin;Gao Aiguo;Jin Qi;Zhou Yingchuan;Wang Ye;Zhang Qin;Li Ding;Gu Xiaofeng(Department of Orthopedics,Wuxi People's Hospital Affiliated to Nanjing Medical University,Wuxi 214000,China)
出处
《中华解剖与临床杂志》
2020年第6期668-672,共5页
Chinese Journal of Anatomy and Clinics
基金
江苏省无锡市科技局科技计划项目(CSE31N1703)。
关键词
椎间盘移位
经皮椎间孔镜
椎间盘切除术
经皮
Intervertebral disc displacement
Percutaneous endoscopic lumbar discectomy
Diskectomy
Percutaneous
