经皮椎间孔镜治疗极外侧型腰椎间盘突出症的临床效果评价  

Clinical evaluation of percutaneous transforaminal endoscopic discectomy in the treatment of far lateral lmnbar disc herniation

作　　者：周跃[1] 李长青[1] 王建[1] 张正丰[1] 初同伟[1] 王卫东[1] 潘勇[1] 郑文杰[1] 罗刚[1] 

机构地区：[1]第三军医大学附属新桥医院骨科,重庆400037

出　　处：《中华创伤杂志》2009年第8期698-704,共7页Chinese Journal of Trauma

摘　　要：目的评价经皮椎间孔镜治疗极外侧型腰椎间盘突出症的手术技巧与临床效果。方法选择2005年9月-2008年10月收治的37例极外侧型腰椎间盘突出症患者，均采用经皮椎间孔镜手术方式治疗。男24例，女13；平均年龄40．6岁。其中椎间孔内型19例（51．4％），椎间孔外型11例（29．7％），混合型7例（18．9％）。平均手术操作时间70min，平均卧床时间9h，手术后平均住院时间5．0d，平均手术花费0．98万元。结果37例患者平均随访11．5个月。疗效评定按照目测视觉类比评分法（VAS）、功能指数评分（ODI）和Nakai分级评定。随访结果显示。患者手术前腿痛VAS指数为8．3±2．3，术后3个月为3．1±1．6，术后6个月为2．9±1．9，手术前后比较差异有统计学意义（P〈0．01）。患者手术前ODI为64．5±23．0，术后3个月为23．6±12．0，术后6个月为12．9±7．0，手术前后比较差异有统计学意义（P〈0．01）。根据Nakai分级：优19例（51％），良13例（35％），中2例（5％），差3例（8％），优良率为87％。结论经皮椎间孔镜手术是治疗极外侧型腰椎间盘突出症安全和有效的微创手术，正确选择患者是保证手术成功的关键。Objective To evaluate surgical techniques and clinical results of pereutaneous transforaminal endoscopic discectomy in the treatment of far lateral lumbar disc herniation. Methods Thirty-seven patients （24 males and 13 females） with far-lateral lumbar disc herniation were treated by pereutaneous transforaminal endoscopic discectomy from September 2005 to October 2008. The mean age of the patients was 40.6 years. There were 19 patients （51.4%） with foraminal lumbar disc herniation, 11 （29.7%） with extraforaminal lumbar disc herniation and 7 （ 18.9% ） with mixed lumbar clisc herniation. The mean operation time, stay-in-bed time, postoperative hospital stay were 70 minutes, 9 hours and 5.0 days respectively. The mean operation costed mean 9 800 ￥ RMB. Results All the patients were followed up for an average period of 11.5 months. The efficacy of percutaneous transforaminal endoscopic discectomy was determined by Visual Analog Score （VAS）, Oswestry Disability Index （ODI） and Nakai criteria. The mean value of VAS was significantly decreased from preoperative 8.3 ± 2.3 to 3.1 ±1.6 at postoperative month 3, and to 2.9 ±1.9 at postoperative month 6 （P 〈 0. 01 ）. The mean value of ODI was significantly decreased from preoperative 64.5 ±23 to 23.6 ±12.0 at postoperative month 3, and to 12.9 ±7.0 at postoperative month 6 （ P 〈 0.01 ）. According to the Nakai criteria, the outcome of the operation was excellent in 19 patients （51%）, good in 13 （35%）, fair in 2 （5%） and poor in 3 （8%）, with overall excellence rate of 87%. Conclusions Transforaminal percutaneous endoscopic discectomy is safe and efficacious in the treatment of far lateral lumbar disc hemiations, and proper selection of patients is the key factor to ensure the outcome of the operation.

关 键 词：腰椎 椎间盘切除术 经皮 极外侧型腰椎间盘突出 

分 类 号：R687.3[医药卫生—骨科学]