椎板间入路椎间孔镜下治疗L2-L5移位型腰椎间盘突出症
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作者Author单位AddressE-Mail
吴冠男 WU Guan-nan 中国中医科学院望京医院脊柱一科, 北京 100102 The First Department of Spinal Surgery, Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing 100102, China  
张世民 ZHANG Shi-min 中国中医科学院望京医院脊柱一科, 北京 100102 The First Department of Spinal Surgery, Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing 100102, China smzhang1117@163.com 
刘昱彰 LIU Yu-zhang 中国中医科学院望京医院脊柱一科, 北京 100102 The First Department of Spinal Surgery, Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing 100102, China  
马明 MA Ming 中国中医科学院望京医院脊柱一科, 北京 100102 The First Department of Spinal Surgery, Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing 100102, China  
靳蛟 JIN Jiao 中国中医科学院望京医院脊柱一科, 北京 100102 The First Department of Spinal Surgery, Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing 100102, China  
黎作旭 LI Zuo-xu 中国中医科学院望京医院脊柱一科, 北京 100102 The First Department of Spinal Surgery, Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing 100102, China  
张兆杰 ZHANG Zhao-jie 中国中医科学院望京医院脊柱一科, 北京 100102 The First Department of Spinal Surgery, Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing 100102, China  
期刊信息:《中国骨伤》2018年,第31卷,第8期,第718-722页
DOI:10.3969/j.issn.1003-0034.2018.08.007
基金项目:
中文摘要:

目的:评价经椎板间隙入路脊柱内窥镜下治疗L2-L5移位型腰椎间盘突出症的手术特点、安全性与临床效果。

方法:2015年11月至2016年10月采用经皮脊柱内窥镜下椎板间隙入路治疗15例移位型腰椎间盘突出症患者,男9例,女6例;年龄19~63岁,平均42岁。患者均有不同程度的腰痛及单侧下肢放射性神经痛,经临床和影像学检查诊断均为单节段移位型腰椎间盘突出。病变节段:L4,5 8例,L3,4 4例,L2,3 3例。按Lee标准将移位的髓核位于椎管内位置分为4个局域:Ⅰ区2例,Ⅱ区3例,Ⅲ区5例,Ⅳ区5例。术前、术后3个月和末次随访时应用VAS和JOA评分对患者腰腿痛和腰椎功能进行评定,末次随访采用MacNab功能标准评定疗效,术后3个月复查腰椎MRI,评估椎间盘突出物切除情况。

结果:15例患者均在局麻下顺利完成手术,无神经根、硬膜囊损伤、术后出血及局部感染等并发症。手术时间45~90 min,平均54.8 min。住院时间3~4 d,平均3 d。15例患者均获随访,时间12~13个月,平均12.2个月,无复发病例。术前、术后3个月与术后12个月的VAS评分分别为8.2±1.4、3.0±0.6、1.7±0.5。术前、术后3个月与术后12个月JOA评分分别为8.76±3.32、23.61±2.14、24.82±3.43,术后各时间点VAS、JOA评分与术前比较差异有统计学意义(P<0.05)。末次随访按MacNab标准评定疗效,结果优9例,良5例,可1例。

结论:经皮脊柱内镜下椎板间隙入路治疗L2-L5移位型腰椎间盘突出症安全、有效,但术中需做椎板成形,局麻下施术患者可能神经刺激反应敏感。
【关键词】椎间盘移位  经皮内窥镜下椎间盘切除术  外科手术,微创性
 
Treatment of displacement-type lumbar intervertebral disc protrusion on L2-L5 with percutaneous endoscopic interlaminar discectomy
ABSTRACT  

Objective:To evaluate the operative characteristic,safety,clinical effect of percutaneous endoscopic interlaminar discectomy (PEID) in treating displacement-type lumbar intervertebral disc protrusion on L2-L5.

Methods:Form November 2015 to October 2016,15 patients with displacement-type lumbar intervertebral disc protrusion were treated with percutaneous endoscopic interlaminar discectomy. There were 9 males and 6 females,aged from 19 to 63 years old with an average of 42 years. All the patients with single-segment displacement-type lumbar intervertebral disc protrusion were diagnosed by clinical and iconography data,and complicated with low back pain and single lower limbs radioactivity pain. Lesion occurred in L4,5 of 8 cases,L3,4 of 4 cases,L2,3 of 3 cases. The patients were divided into 4 regions according to Lee standard (displaced nucleus pulposus location on spinal canal),Ⅰ region was 2 cases,Ⅱ region was 3 cases,Ⅲ region was 5 cases,Ⅳ region was 5 cases.Preoperative,postoperative 3 months,final follow-up,lumbago-leg pain and lumbar function were assessed by VAS,JOA scores;at final follow-up,MacNab was used to evaluate the clinical effect;postoperative 3 months,rechecked lumbar MRI to observe discectomy condition.

Results:All the operations were successfully complete under local anesthesia,and no complications such as injuries of nerve root and dural sac,postoperative hemorrhage,local infection were found. Operative time was 45 to 90 min with an average of 54.8 min;and hospitalization time was 3 to 4 days with an average of 3 days. All 15 cases were followed up for 12 to 13 months with an average of 12.2 months,no recurrence was found. Preoperation,postoperative 3,12 months,VAS scores were 8.2±1.4,3.0±0.6,1.7±0.5,JOA scores were 8.76±3.32,23.61±2.14,24.82±3.43,respectively. Postoperative VAS,JOA scores were obviously improved(P<0.05). According to MacNab standard to evaluate the clinical effect,9 cases obtained excellent results,5 good,1 fair.

Conclusion:PEID is a micro-trauma surgical method and has advantage of safe and effective in treating displacement-type lumbar intervertebral disc protrusion on L2-L5,but requires laminoplasty during operation,and under local anesthesia to operation maybe can induce neurostimulation.
KEY WORDS  Intervertebral disk displacement  Percutaneous endoscopic interlaminar discectomy  Surgical procedures,minimally invasive
 
引用本文,请按以下格式著录参考文献:
中文格式:吴冠男,张世民,刘昱彰,马明,靳蛟,黎作旭,张兆杰.椎板间入路椎间孔镜下治疗L2-L5移位型腰椎间盘突出症[J].中国骨伤,2018,31(8):718~722
英文格式:WU Guan-nan,ZHANG Shi-min,LIU Yu-zhang,MA Ming,JIN Jiao,LI Zuo-xu,ZHANG Zhao-jie.Treatment of displacement-type lumbar intervertebral disc protrusion on L2-L5 with percutaneous endoscopic interlaminar discectomy[J].zhongguo gu shang / China J Orthop Trauma ,2018,31(8):718~722
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