椎间孔镜治疗脱出型腰椎间盘突出症19例  

Treatment of 19 Cases of Prolapsed Lumbar Disc Herniation by Transforaminal Endoscopic Spine System(TESSYS)

作　　者：隰建成[1] 马远征[1] 崔旭[1] 胡明[1] 刘向东[1] 白一冰[1] 

机构地区：[1]解放军第309医院骨科,北京100091

出　　处：《实用骨科杂志》2012年第10期876-879,共4页Journal of Practical Orthopaedics

摘　　要：目的探讨椎间孔镜治疗脱出型腰椎间盘突出症的疗效、围手术期并发症及处置对策。方法选择自2009年11月至2011年5月在我院应用椎间孔镜治疗的19例随访资料完整的脱出型腰椎间盘突出症患者,随访时间6个月～2年,平均随访13个月,比较术前、术后即刻、1周、3个月、6个月、12个月、22个月的JOA、VAS及Oswestry(2.0版本)评分,分析术中、术后并发症的情况,并探讨处置对策。结果 19例患者术后JOA评分较术前明显升高,术后VAS和Oswestry评分较术前明显降低,有统计学意义(P<0.01)。常见术中并发症包括:a)硬膜撕裂1例;b)神经根挫伤1例;c)异物进入椎管1例;d)导针断裂1例。常见术后并发症包括:a)股四头肌麻痹1例;b)椎间隙或椎管感染1例;c)马尾神经损伤1例;d)术后水肿反应12例。结论椎间孔镜技术是治疗脱出型腰椎间盘突出症的有效方法,但可能发生并发症。严格的围手术期处理和谨慎的术中操作可预防或减少并发症的发生。Objective To investigate the therapeutic effect,complications and disposal strategy on treatment of prolapsed lumbar disc herniation by transforaminal endoscopic spine system（TESSYS）.Methods From 2009.11.to 2011.05 comparison of preoperative and postoperative,JOA,VAS and Oswestry（version 2.0） score were performed in prolapsed lumbar disc herniation patients.The peri-operative complications and disposal strategym were analyzed.The time of follow-up was 6 months～2 years.The average time of follow-up was 13 months.Results Postoperative JOA score was significantly increased compared with preoperative score（P0.01）.Postoperative VAS and Oswestry score decreased significantly compared with preoperative score（P0.01）.The common complications during operation included that 1 case of laceration of dura,1 case of contusion of nerve root,1 case of extraneous material entered vertebral canal and 1 case of guide pin broken.The common postoperative complications included 1 case of paralysis of quadriceps femoris,1 case of infection,1 case of injury of coccygeal nerve and 12 cases of postoperative edema response.Conclusion Prolapsed lumbar disc herniation can be effectively treated with TESSYS,but the complications may happened.The complications can be prevented and diminished by strict perioperative disposal and prudent manipulation.

关 键 词：椎间孔镜 经皮椎间盘切除 脱出型腰椎间盘突出 疗效 并发症 

分 类 号：R681.53[医药卫生—骨科学]