脊柱内镜手术治疗下肢剧烈放射痛的微小腰椎间盘突出
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作者Author单位AddressE-Mail
王宇 WANG Yu 温州医科大学附属第一医院脊柱外科, 浙江 温州 325000 Department of Spine Surgery, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejiang, China  
滕红林 TENG Hong-lin 温州医科大学附属第一医院脊柱外科, 浙江 温州 325000 Department of Spine Surgery, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejiang, China 907173102@qq.com 
朱旻宇 ZHU Min-yu 温州医科大学附属第一医院脊柱外科, 浙江 温州 325000 Department of Spine Surgery, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejiang, China  
黄克伦 HUANG Ke-lun 温州医科大学附属第一医院脊柱外科, 浙江 温州 325000 Department of Spine Surgery, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejiang, China  
林超伟 LIN Chao-wei 温州医科大学附属第一医院脊柱外科, 浙江 温州 325000 Department of Spine Surgery, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejiang, China  
期刊信息:《中国骨伤》2020年,第33卷,第6期,第508-513页
DOI:10.12200/j.issn.1003-0034.2020.06.004
基金项目:
中文摘要:

目的:研究伴有严重症状的微小腰椎间盘突出的临床特征及采用经皮脊柱内镜腰椎间盘摘除术治疗的手术疗效。

方法:回顾性分析2014年1月至2019年2月行经皮脊柱内镜腰椎间盘摘除术治疗的伴有严重症状的微小腰椎间盘突出患者34例,其中男20例,女14例,年龄31~73(48.8±10.1)岁,随访时间8~48(21.8±10.3)个月。分析其临床表现、影像学和手术相关资料,术前、术后1个月和末次随访时进行视觉模拟评分(visual analogue scale,VAS),Oswestry功能障碍指数(Oswestry Disability Index,ODI)评分,比较术前和术后评分,末次随访采用Macnab疗效评定标准评级评价手术疗效。

结果:34例均以单侧下肢剧烈放射痛为主要症状,术前症状持续时间0.33~84个月。椎间盘突出位于L4,5的7例,L5S1的27例。根据腰椎间盘突出MSU分区,31例位于B区。所有病例术中证实突出髓核压迫神经根,26例神经根明显红肿。手术时间30~80(43.5±9.5)min,术前VAS评分(8.1±1.3)分,ODI评分(31.8±6.7)分;术后1个月和末次随访的VAS评分分别为(1.1±0.3)分和(0.7±0.4)分,ODI分别为(5.3±2.1)分,及0~10分,中位分值2分,术后均较术前改善。术后末次随访进行Macnab疗效评定,优28例,良6例。在随访期内仅1例出现椎间盘突出原位复发。

结论:伴有严重症状的微小腰椎间盘突出患者以单侧下肢剧烈放射痛为主要症状,往往起病较急,病程较短,突出髓核一般仅卡压神经根出硬膜段,局部炎症重。对于此类患者,薄层CT扫描具有重要的诊断价值。采用经皮脊柱内镜腰椎间盘摘除术治疗此类患者,症状缓解迅速,疗效确切,复发率低。
【关键词】腰椎  椎间盘移位  脊柱内镜手术  治疗结果
 
Clinical outcomes of spinal endoscopic surgery for tiny lumbar disc herniation with severe radiating pain of lower limb
ABSTRACT  

Objective: To study the clinical characteristics of the patients with tiny lumbar disc herniation and severe symptoms(tLDHSS) and the therapeutic effects of percutaneous endoscopic lumbar discectomy(PELD).

Methods: From January 2014 to February 2019,34 patients with tLDHSS were reviewed retrospectively,including 20 males and 14 females,aged from 31 to 73(48.8±10.1) years,with a follow-up duration ranged from 8 to 48(21.8±10.3) months. The clinical manifestations,imaging and surgical data were analyzed. The visual analogue scale(VAS) and Oswestry Disability Index(ODI) scores were analyzed before operation,1 month after operation and at the latest follow-up. The preoperative and postoperative scores were compared. At the latest follow-up,the Macnab system was used to evaluate the effects of the operation.

Results: The main symptom of 34 cases was severe radiation pain on one side of lower limbs. The duration of preoperative symptoms ranged from 0.33 to 84 months. The disc herniation was found in 7 cases of L4,5 and 27 cases of L5S1. According to the MSU division of lumbar disc herniation,31 cases were located in area B. In all cases,it was confirmed that the protruding nucleus compressed the nerve root,and in 26 cases,the nerve root was obviously inflamed. The operation time ranged from 30 to 80 min,with a mean time of(43.5±9.5) min. The preoperative VAS score was 8.1±1.3 and ODI score was 31.8±6.7. And the VAS score was 1.1±0.3,0.7±0.4 on the first month after operation and the latest follow-up,respectively. The ODI score was 5.3±2.1 and 0 to 10(with a median score of 2) on the first month after operation and the latest follow-up respectively. The postoperative VAS and ODI scores were improved compared with preoperative scores. At the latest follow-up,28 cases got an excellent result and 6 cases good according to Macnab evaluation system. During the follow-up period,only one patient had recurrent disc herniation.

Conclusion: The main symptom of patients with tLDHSS is severe radiation pain on one side of lower limb. It manifests as sudden onset and shorter course of disease. Severe local inflammation was induced by local compression of the protruding nucleus pulposus on the nerve root out of the dura. For this kind of patients,thin-layer CT scan has an important diagnostic value. In the treatment of this kind of patients,the symptoms are relieved rapidly,the curative effect is definite and the recurrence rate is low.
KEY WORDS  Lumbar vertebrae  Intervertebral disc displacement  Spinal endoscopic surgery  Treatment outcome
 
引用本文,请按以下格式著录参考文献:
中文格式:王宇,滕红林,朱旻宇,黄克伦,林超伟.脊柱内镜手术治疗下肢剧烈放射痛的微小腰椎间盘突出[J].中国骨伤,2020,33(6):508~513
英文格式:WANG Yu,TENG Hong-lin,ZHU Min-yu,HUANG Ke-lun,LIN Chao-wei.Clinical outcomes of spinal endoscopic surgery for tiny lumbar disc herniation with severe radiating pain of lower limb[J].zhongguo gu shang / China J Orthop Trauma ,2020,33(6):508~513
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