经皮内镜椎弓根锚定技术治疗高度游离型腰椎间盘突出症
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作者Author单位AddressE-Mail
王想福 WANG Xiang-fu 甘肃省中医院, 甘肃 兰州 730050 Gansu Provincial Hospital of Traditional Chinese Medicine, Lanzhou 730050, Gansu, China  
叶丙霖 YE Bing-lin 甘肃省中医院, 甘肃 兰州 730050 Gansu Provincial Hospital of Traditional Chinese Medicine, Lanzhou 730050, Gansu, China  
孙凤歧 SUN Feng-qi 甘肃省中医院, 甘肃 兰州 730050 Gansu Provincial Hospital of Traditional Chinese Medicine, Lanzhou 730050, Gansu, China  
陈伟国 CHEN Wei-guo 甘肃省中医院, 甘肃 兰州 730050 Gansu Provincial Hospital of Traditional Chinese Medicine, Lanzhou 730050, Gansu, China 571072508@qq.com 
期刊信息:《中国骨伤》2020年,第33卷,第6期,第514-518页
DOI:10.12200/j.issn.1003-0034.2020.06.005
基金项目:兰州市科技局医疗卫生专项(编号:2017-4-72)
中文摘要:

目的:探讨经皮脊柱内镜经椎弓根锚定技术治疗高度脱垂游离型腰椎间盘突出症的临床疗效,分析其手术技巧。

方法:2016年5月至2018年6月,运用经皮脊柱内镜技术经椎弓根入路治疗向下高度脱垂游离型腰椎间盘突出症患者24例。其中男11例,女13例;L2,3 1例,L3,4 5例,L4,5 18例;年龄48~72(59.5±7.2)岁;病程8~26(16.2±6.3)个月。所有患者采用局部浸润麻醉,在术前1 d,术后1周及术后3、6、12个月运用疼痛视觉模拟评分(visual analogue scale,VAS)及Oswestry功能障碍指数(Oswestry Disability Index,ODI)评估患者症状改善情况,并采用改良Macnab评价体系评估临床疗效,对所取得的数据运用SPSS 22.0进行统计分析。

结果:术后所有患者获得随访,时间12~24(17.5±5.3)个月。手术时间(69.8±14.2)min,1例出现脑脊液漏,术后平卧休息后好转,其余23例未出现手术并发症,术后所有患者腰腿部疼痛、下肢麻木有不同程度的好转。术前1 d,术后1周及术后3、6、12个月腰痛VAS评分分别为6.36±1.27,3.94±1.03,1.62±0.87,0.44±0.27,0.37±0.29,术后不同时间腰痛VAS评分均较术前改善(P<0.05);腿痛VAS评分分别为8.28±1.74,3.16±1.24,2.83±1.13,0.83±0.31,0.46±0.31,术后不同时间腿痛VAS评分均较术前改善(P<0.05)。术前1 d,术后1周及术后3、6、12个月ODI分别为(48.79±9.83)%,(36.51±11.24)%,(21.05±6.35)%,(9.83±4.62)%,(7.24±4.72)%,术后不同时间ODI评分均较术前改善(P<0.05)。术后1年随访时采用改良Macnab评价体系评价患者的临床疗效,优19例,良3例,中2例,差0例。

结论:经皮脊柱内镜经椎弓根锚定技术治疗向下高度脱垂游离型腰椎间盘突出症可有效改善患者的临床症状,并且具有创伤小、出血少、恢复快、髓核摘除完全、患者痛苦小等优点,其临床疗效确切,可操作性较强,值得推广使用。
【关键词】腰椎  椎间盘移位  脊柱内镜手术  微创外科手术
 
Transforaminal percutaneous endoscopic lumbar discectomy combined with anchorage technique of pedicle for the treatment of high prolapse free lumbar disc herniation
ABSTRACT  

Objective: To investigate the clinical effects of percutaneous spinal endoscopy (percutaneous endoscopy) in the treatment of high prolapse free lumbar disc herniation.

Methods: From May 2016 to June 2018,24 patients with highly prolapse free lumbar disc herniation were enrolled in this study,including 11 males and 13 females,ranging in age from 48 to 72 years old,with an average of (59.5±7.2) years old. There were 1 case of L2,3,5 cases of L3,4,18 cases of L4,5. The course of disease ranged from 8 to 26 months,with an average of (16.2±6.3) months. All the patients were subjected to local infiltration anesthesia. The clinical outcomes were evaluated by visual analog scale(VAS) for leg pain,low back pain and Oswestry Disability Index(ODI) at preoperative,first day after operation and 6 month after surgery. All data were statisticed by SPSS 22.0.

Results: All the patients were followed up,and the duration ranged from 12 to 24 months, with a mean of (17.5±5.3) months. The average operation time was(69.8±14.2) minutes. One patient had cerebrospinal fluid leakage,which improved after supine rest. VAS scores of lower back pain were 6.36±1.27,3.94±1.03,1.62±0.87,0.44±0.27,0.37±0.29. VAS scores of leg pain were 8.28±1.74,3.16±1.24,2.83±1.13,0.83±0.31,0.46±0.31,and the differences were statistically significant (P<0.05). The ODI were (48.79±9.83)%,(36.51±11.24)%,(21.05±6.35)%,(9.83±4.62)% and (7.24±4.72)% 1 day before and 1 weeks,3 months,6 months and 1 year after the operation,respectively. One year after the operation,the modified Macnab evaluation system was used to evaluate the clinical efficacy of the patients,19 patients got an excellent result,3 good,2 fair and 0 poor.

Conclusion: Percutaneous endoscopic pedicle anchoring technique for the treatment of high prolapse free lumbar disc herniation can effectively improve the clinical symptoms of patients,and has the advantages of less trauma,less bleeding,rapid recovery,complete removal of the nucleus pulposus,and less pain of patients,etc.,its clinical efficacy is accurate,operability is strong,it is worth promoting in the clinical use.
KEY WORDS  Lumbar vertebrae  Intervertebral disc displacement  Spinal endoscopic surgery  Minimal surgical procedures
 
引用本文,请按以下格式著录参考文献:
中文格式:王想福,叶丙霖,孙凤歧,陈伟国.经皮内镜椎弓根锚定技术治疗高度游离型腰椎间盘突出症[J].中国骨伤,2020,33(6):514~518
英文格式:WANG Xiang-fu,YE Bing-lin,SUN Feng-qi,CHEN Wei-guo.Transforaminal percutaneous endoscopic lumbar discectomy combined with anchorage technique of pedicle for the treatment of high prolapse free lumbar disc herniation[J].zhongguo gu shang / China J Orthop Trauma ,2020,33(6):514~518
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