复发性腰椎间盘突出症的微创手术治疗  

The minimally invasive surgery for treating recurrent lumbar disc protrusion

作　　者：吴辉 胡凌云 林宏 

机构地区：[1]四川省南充市中心医院骨科,637000

出　　处：《重庆医学》2014年第27期3556-3558,共3页Chongqing medicine

基　　金：国家自然科学基金资助项目(81100929)

摘　　要：目的：探讨微创手术通道下治疗复发性腰椎间盘突出症的临床效果。方法回顾性分析2009年7月到2013年7月行微创椎间盘切除术治疗的30例腰椎间盘突出症术后复发患者的临床资料，患者复发节段腰34（L34）1例，腰45（L45）10例，腰5骶1（L5S1）19例；统计描述患者的年龄、体质量指数、复发节段、手术时间、术中失血量、术后无痛行走的时间，采用疼痛视觉模拟评分（VAS）评估微创手术治疗的临床疗效。结果手术时间50～100min，平均65min；术中失血量100～180mL，平均145mL；住院时间9～16d，平均13d；平均住院费用7300元；术后无痛行走时间7～15d，平均11d；术后从事非体力劳动的时间27．3d，VAS分值由术前的（7．3±1．3）分降低到术后（3．1±0．9）分，末次随访时为（2．2±0．6）分，术后、末次随访VAS分值与术前比较，差异均有统计学意义（P＜0．05）。获得随访时间6～33个月，平均16．5个月。疗效优16例，良7例，可5例，差2例，优良率76％。结论微创手术是治疗复发性腰椎间盘突出症的有效方法之一。Objective To study the clinical effect of the minimally invasive surgery for treating recurrent lumbar disc protrusion . Methods Thirty operative cases of recurrent lumbar disc protrusion treated with the minimally invasive surgery from July 2009 to July 2013 were retrospectively analyzed for statistically describing the age ,body mass index ,recurrent segment ,operating time ,intr-aoperative bleeding volume and postoperative painless walking time .The recurrence segments were 1 case of L34 ,10 cases of L45 and 19 cases of L5 S1 ;the visual analogue scale （VAS） was adopted to evaluate the operative effect .Results The operating time was 65 min on average （50-100）min;mean intraoperative bleeding volume was 145 mL（100-180）mL ;average length of hospital stay was 13 d （9-16）d;average hospitalization costs were 7 300 Yuan;average postoperative painless walking time was 11 d （7-15）d;post-operative non-manual labor work time was 27 .3 d .The VAS score was reduced from （7 .3 ± 1 .3） before operation to （3 .1 ± 0 .9） after operation and （2 .2 ± 0 .6） at the last follow-up ,which was statistically significant（P〈0 .05） .Followed up for 6-33 months , average 16 .5 months .Superior efficacy in 16 cases ,gord in 7 cases ,average in 5 cases ,bad in 2 cases ,the rate of good efficacy was 76% .Conclusion The minimally invasive surgery is one of effective methods to treat postoperative recurrence of lumbar disc pro-trusion .

关 键 词：外科手术 微创性 髓核摘除术 复发性腰椎间盘突出症 

分 类 号：R687.3[医药卫生—骨科学]