内镜治疗腰椎间盘突出症合并椎体后缘离断
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作者Author单位AddressE-Mail
陈少初 CHEN Shao-chu 深圳市龙华区人民医院脊柱外科, 广东 深圳 518109 Department of Spine Surgery, People's Hospital of Longhua, Shenzhen 518109, Guangdong, China  
张昊 ZHANG Hao 深圳市龙华区人民医院脊柱外科, 广东 深圳 518109 Department of Spine Surgery, People's Hospital of Longhua, Shenzhen 518109, Guangdong, China zhanghaodoctor@hotmail.com 
龚铭 GONG Ming 深圳市龙华区人民医院脊柱外科, 广东 深圳 518109 Department of Spine Surgery, People's Hospital of Longhua, Shenzhen 518109, Guangdong, China  
周建华 ZHOU Jian-hua 深圳市龙华区人民医院脊柱外科, 广东 深圳 518109 Department of Spine Surgery, People's Hospital of Longhua, Shenzhen 518109, Guangdong, China  
胡亚威 HU Ya-wei 深圳市龙华区人民医院脊柱外科, 广东 深圳 518109 Department of Spine Surgery, People's Hospital of Longhua, Shenzhen 518109, Guangdong, China  
张望 ZHANG Wang 深圳市龙华区人民医院脊柱外科, 广东 深圳 518109 Department of Spine Surgery, People's Hospital of Longhua, Shenzhen 518109, Guangdong, China  
郭增峰 GUO Zeng-feng 深圳市龙华区人民医院脊柱外科, 广东 深圳 518109 Department of Spine Surgery, People's Hospital of Longhua, Shenzhen 518109, Guangdong, China  
邓岳 DENG Yue 深圳市龙华区人民医院脊柱外科, 广东 深圳 518109 Department of Spine Surgery, People's Hospital of Longhua, Shenzhen 518109, Guangdong, China  
期刊信息:《中国骨伤》2020年,第33卷,第6期,第519-523页
DOI:10.12200/j.issn.1003-0034.2020.06.006
基金项目:
中文摘要:

目的:探讨全脊柱内镜下治疗腰椎间盘突出症合并椎体后缘离断的有效性及安全性。

方法:自2015年1月至2018年1月,采用全脊柱内镜治疗腰椎间盘突出症合并椎体后缘离断患者21例,男17例,女4例;年龄18~48岁,中位年龄27岁,其中16例<30岁;病程6个月~5年,中位病程21个月。均为单节段单侧椎间盘突出,采用椎板间入路,于镜下症状侧单侧摘除突出椎间盘,全部或部分切除离断的骨块。

结果:所有病例无切口感染、椎间隙感染、肠道损伤、硬脊膜损伤、脑脊液漏等并发症发生。手术时间32~92 min,中位时间57 min。术后影像学检查示椎体后缘离断骨块完全切除2例,部分切除16例,未切除3例;椎间盘均彻底摘除。21例均获随访,时间12~36个月,中位时间15个月。腰痛视觉模拟评分(visual analogue scale,VAS)评分,术前(7.10±1.20)分,术后3 d(3.46±0.23)分,术后6个月(2.36±0.19)分;腿痛VAS评分,术前(8.80±0.55)分,术后3 d(3.54±0.28)分,术后6个月(2.59±0.26)分;Oswestry功能障碍指数评分,术前(69.71±9.37)%,术后6个月(32.19±6.95)%,末次随访(20.95±6.16)%。术后1年采用改良Macnab术后疗效评定标准进行评定,优16例,良4例,可1例。

结论:经椎板间入路全脊柱内镜可作为治疗腰椎间盘突出症合并椎体后缘离断的一种治疗方法,可减少创伤、少损伤腰背肌的同时达到与开放手术相似的减压效果,远期疗效需更大样本量的前瞻随机对照研究进一步证明。
【关键词】腰椎  椎间盘移位  脊柱内镜手术  治疗结果
 
Clinical efficacy of endoscopy in the treatment of lumbar disc herniation combined with posterior apophyseal ring separation
ABSTRACT  

Objective: To investigate the efficacy and safety of total spine endoscopy in the treatment of lumbar disc herniation combined with posterior apophyseal ring separation.

Methods: From January 2015 to January 2018,a total of 21 patients with lumbar disc herniation complicated with posterior apophyseal ring separation were treated with total spine endoscopy via interlamina approach. There were 17 males and 4 females. The age ranged from 18 to 48 years old and the median age was 27 years old. All were single segment unilateral disc herniation,interlaminar approach was adopted,and the herniated disc was removed unilaterally at the symptomatic side under the microscope,and all or part of the broken bone was removed.

Results: There were no complications such as incision infection,intervertebral space infection,intestinal injury,dural injury and cerebrospinal fluid leakage. The operation time ranged from 32 to 92 minutes and the median time was 57 minutes. Postoperative imaging examination showed that 2 patients had complete resection of osteotomy of posterior edge of vertebral body,16 patients had partially resection and 3 patients had no resection. All intervertebral discs were completely removed. All 21 patients were followed up,and the duration ranged from 12 to 36 months,with a median of 15 months. The VAS of lumbago was 7.10±1.20 before surgery,3.46±0.23 on the 3rd day after surgery,2.36±0.19 on the 6th month after surgery; and the VAS of leg pain was 8.80±0.55 before surgery,3.54±0.28 on the 3rd day after surgery,and 2.59±0.26 on the 6th month after surgery. The Oswestry Disability Index score was (69.71±9.37)% before surgery,(32.19±6.95)% on the 6th month after surgery,and (20.95±6.16)% at the latest follow-up. On the 1st year after operation,16 patients got an excellent result,4 good and 1 fair according to Macnab evaluation system.

Conclusion: Total spine endoscopy via interlaminal approach can be used as an option in the treatment of lumbar disc herniation combined with vertebral posterior margin dissociation,which can reduce trauma and injury to the lumbar dorsal muscle and achieve similar decompression effect as open surgery. The long-term efficacy needs to be further proved by prospective randomized controlled studies with larger sample size.
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:陈少初,张昊,龚铭,周建华,胡亚威,张望,郭增峰,邓岳.内镜治疗腰椎间盘突出症合并椎体后缘离断[J].中国骨伤,2020,33(6):519~523
英文格式:CHEN Shao-chu,ZHANG Hao,GONG Ming,ZHOU Jian-hua,HU Ya-wei,ZHANG Wang,GUO Zeng-feng,DENG Yue.Clinical efficacy of endoscopy in the treatment of lumbar disc herniation combined with posterior apophyseal ring separation[J].zhongguo gu shang / China J Orthop Trauma ,2020,33(6):519~523
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