经皮内镜不同入路治疗腰椎间盘突出临床分析  

Percutaneous endoscopic treatment of lumbar disc endoscopic via different approaches:a clinical analysis

作　　者：汤锋武[1] 陈旭义[1] 蒋显锋[1] 韩广[1] 赵长宇[1] 苗翠云[1] 

机构地区：[1]武警后勤学院附属医院脑系科,天津300162

出　　处：《中华神经外科疾病研究杂志》2014年第5期416-419,共4页Chinese Journal of Neurosurgical Disease Research

基　　金：国家自然科学基金资助项目(11102235);天津市自然科学基金重点资助项目(12JCZDJC24100);天津市卫生局科技基金资助项目(2013KZ134);武警后勤学院附属医院种子基金资助项目(FYM201432)

摘　　要：目的分析比较经皮内镜下椎间孔镜入路与椎板间入路治疗腰椎间盘突出患者的近期临床疗效及优缺点。方法 2009年12月至2012年12月我院收治的89例腰椎间盘突出症患者,分别采用内镜下椎间孔入路(63例)及椎板间入路(26例)腰椎间盘切除术。分析比较其手术适应证、手术操作时间、卧床及术后平均住院时间,跟踪分析各组术前及术后6个月内疗效及并发症。结果经皮内镜椎间孔入路及椎板间入路下平均手术操作时间分别为85 min及66 min,平均卧床时间为8.6 h及8.5 h,手术后平均住院时间为4.8 d及3.9 d。椎间孔入路组术前视觉模拟评分法(VAS)评分为(8.9±1.8)分,术后3 w为(1.4±0.3)分、术后3个月为(0.9±0.2)分、术后6个月为(0.5±0.1)分;椎板间入路组术前VAS评分为(8.7±2.4)分,术后3 w为(1.1±0.3)分、术后3个月为(0.9±0.2)分、术后6个月为(0.7±0.2)分。术后6个月,椎间孔入路组优良率89.6%,椎板间入路组92.0%。两组均无永久性神经根损伤和硬脊膜囊撕裂等并发症。结论经皮内镜下椎间孔入路及椎板间入路均能获得满意疗效。根据腰椎间盘突出不同类型和部位,选择正确入路是手术成功的关键。Objective The clinical effects of percutaneous endoscopic discectomy via different approaches for the patients with lumbar disc herniation are discussed. Methods A total of 89 patients with lumbar disc herniation treated by endoscopic transforaminal approach（63 cases） and interlaminar approach（26 cases）from 2009 December to 2012 December were analyzed. The indications,operation time,bed time and average postoperative hospitalization time were compared and the curative effect and complications were analyzed before and after operation. Results The average operation time for percutaneous endoscopic transforaminal approach and interlaminal approach was 85 min and 66 min; average bed time was 8. 6 h and 8. 5 h; the average hospitalization time after operation was 4. 8 d and 3. 9 d,respectively. Preoperative visual analogue scale score（ VAS） in transforaminal approach group was 8. 9 ± 1. 8 pre-operation,1. 4 ± 0. 3 at 3 w after operation,0. 9 ± 0. 2 at 3months after operation,0. 5 ± 0. 1 at 6 months after operation,respectively; preoperative VAS in interlaminar approach group was 8. 7 ± 2. 7 pre-operation,1. 1 ± 0. 3 at 3 w after operation,0. 9 ± 0. 2 at 3 months after operation,0. 7 ±0. 2 at 6 months after operation,respectively. The good recovery rate was 89. 2% in transforaminal group and 92. 4% in interlaminar approach group at 6 months after operation. No permanent nerve roots and dural sac tear ocurred. Conclusion Percutaneous endoscopic transforaminal and interlaminar approaches are satisfactory in the effect. A proper approach is the key for the successful operation according to the location and types of lumbar disc herniation.

关 键 词：经皮内镜 椎间孔 腰椎间盘突出症 手术入路 

分 类 号：S857.128[农业科学—临床兽医学]