摘要
目的：探讨经皮内镜椎板间入路微创治疗游离脱垂型L5～S1椎间盘突出症的手术技巧及临床疗效。方法2010年1月至2012年6月，我科采用经皮内镜椎板间入路椎间盘切除术（percutaneousendoscopicinterlaminardiscectomy，PEID）微创治疗游离脱垂型L5～S1椎间盘突出症94例。其中男53例，女41例，年龄13～56（平均29.69）岁。采用疼痛视觉模拟评分（visualanaloguescale，VAS）、Oswestry功能障碍指数（oswestrydisabilityindex，ODI）、改良MacNab评价临床疗效。结果平均随访26.5（12～37）个月。平均手术时间（66.4±8.4）min。每台手术术中平均透视时间（0.5±0.2）s。所有患者术后腰腿痛、感觉肌力减退均有不同程度的缓解。术前、术后1天、术后1、3、6、12个月腰痛VAS评分分别为：（5.40±1.12）分，（3.36±0.96）分，（1.86±0.99）分，（1.18±0.83）分，（0.78±0.62）分，（0.58±0.64）分；腿痛VAS评分分别为：（8.40±0.95）分，（2.66±1.53）分，（1.98±1.00）分，（1.20±0.81）分，（0.82±0.66）分，（0.68±0.62）分。术前、术后1、3、6、12个月ODI指数分别为：51.88±8.88，33.22±10.33，23.46±7.47，15.10±5.72，10.38±5.93。术前与术后各时段腰腿痛VAS评分及ODI指数差异有统计学意义（P＜0.01）。末次随访时改良MacNab评价疗效，优良率94.7%。结论经皮内镜椎板间入路椎间盘切除术微创治疗游离脱垂型L5～S1椎间盘突出症具有创伤小、出血少、术中透视少、术后恢复快等优点，其近期疗效确切，远期结果有待进一步随访。
Objective To investigate the surgical techniques and clinical effects of percutaneous endoscopic interlaminar discectomy （ PEID ） in the treatment of prolapsed and sequestrated L5-S1 lumbar disc herniation. Methods A total of 94 patients with L5-S1 prolapsed and sequestrated lumbar disc herniation were treated by PEID from January 2010 to June 2012. There were 53 males and 41 females, whose average age was 29.69 years old （ range：13-56 years ）. The Visual Analogue Scale （ VAS ）, Oswestry Disability Index （ ODI ） and modiifed MacNab criteria were used for the evaluation of clinical effects. Results All the patients were followed up for a mean period of 26.5 months （ range：12-37 months ）. The mean operation time was （ 66.4±8.4 ） min. The average intraoperative fluoroscopy time was （ 0.5±0.2 ） s. Sensory disturbance, muscle weakness and low back and leg pain were alleviated in different degrees after the operation in all the patients. The VAS scores of low back pain were （ 5.40±1.12 ）, （ 3.36±0.96 ）, （ 1.86±0.99 ）, （ 1.18±0.83 ）, （ 0.78±0.62 ） and （ 0.58±0.64 ） point preoperatively and at 1 day, 1 month, 3 months, 6 months and 12 months after the operation. The VAS scores of leg pain was （ 8.40±0.95 ）, （ 2.66±1.53 ）, （ 1.98±1.00 ）, （ 1.20±0.81 ）, （ 0.82±0.66 ） and （ 0.68±0.62 ） point in the corresponding follow-up time. The ODI scores were 51.88±8.88, 33.22±10.33, 23.46±7.47, 15.10±5.72 and 10.38±5.93 preoperatively and at 1 month, 3 months, 6 months and 12 months after the operation. Statistically signiifcant differences existed in the VAS scores and ODI scores of low back and leg pain preoperatively and in the corresponding follow-up time （ P〈0.01 ）. The excellent and good rate was 94.7% in the latest follow-up according to the modiifed MacNab criteria. Conclusions PEID is a safe, effective and minimally invasive procedure in the treatment of prolapsed and sequestrated L5-S1 lumbar disc herniation, with the advantages of less trauma, less blood loss, less intraoperative lfuoroscopy and quick recovery. Its short-term results are satisfactory, while its long-term outcomes require further follow-ups.
出处
《中国骨与关节杂志》
CAS
2014年第8期590-596,共7页
Chinese Journal of Bone and Joint
基金
卫生部行业科研专项基金(201002018)
关键词
椎间盘移位
腰椎
外科手术
微创性
椎间盘切除术
经皮
椎板间入路
Intervertebral disc displacement
Lumbar vertebrae
Surgical procedures,minimally invasive
Diskectomy,percutaneous
Percutaneous endoscopic interlaminar discectomy
