经皮内镜椎间孔入路微创治疗复发性腰椎间盘突出症疗效分析  

EFFECTIVENESS OF PERCUTANEOUS ENDOSCOPIC TRANSFORAMINAL DISCECTOMY FOR RECURRENT LUMBAR DISC HERNIATION

作　　者：李柱海 曾建成[1] 宋跃明[1] 孔清泉[1] 王贤帝[1] 陈果[1] 聂鸿飞[1] 蒋虎山 

机构地区：[1]四川大学华西医院骨科,成都610041

出　　处：《中国修复重建外科杂志》2015年第1期43-47,共5页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：卫生公益性行业科研专项经费资助项目(201002018)~~

摘　　要：目的评价经皮内镜椎间孔入路微创治疗复发性腰椎间盘突出症的可行性和有效性。方法 2009年6月-2011年12月,采用经皮内镜椎间孔入路腰椎间盘髓核摘除术治疗复发性腰椎间盘突出症患者56例,其中男30例,女26例;年龄24-70岁,平均50岁。突出节段：L3、4 3例,L4、5 34例,L5-S1 19例。与初次手术同侧突出48例,对侧突出8例。无症状间歇期6个月-27年,平均5.5年。术前采用疼痛视觉模拟评分（visual analogue scale,VAS）评分：腰痛（6.18±1.44）分,腿痛（7.66±1.03）分。患者均在局麻下完成手术,术后随访患者症状改善情况,采用VAS评分、改良Mac Nab标准评估临床疗效。结果手术时间30-100 min,平均60.4 min;住院时间3-6 d,平均5.1 d10患者均获随访,随访时间24-56个月,平均28.2个月。患者术后即刻疼痛均有不同程度缓解,术后1、3、12个月及末次随访时腰痛及腿痛VAS评分均较术前明显下降,差异有统计学意义（P〈0.05）。术后12个月,采用改良Mac Nab标准评价疗效,获优39例,良9例,可5例,差3例,优良率85.7%。5例（8.9%）术后发生手术相关并发症;1例（1.8%）术后18个月再次复发,行相应节段减压及椎间融合术后症状缓解。结论经皮内镜椎间孔入路腰椎间盘髓核摘除术可以避开后方瘢痕组织,降低了手术相关并发症的发生率,且创伤小,手术时间短,恢复快,是微创治疗复发性腰椎间盘突出症的有效方法。Objective To determine the feasibility and effectiveness of percutaneous endoscopic transforaminal discectomy（PETD） for recurrent lumbar disc herniation（RLDH）. Methods Between June 2009 and December 2011,56 patients with RLDH underwent PETD after local anesthesia,including 30 males and 26 females,with a mean age of 50 years（range,24-70 years）. The involved segments were L3,4 in 3 cases,L4,5 in 34 cases,and L5-S1 in 19 cases. Of 56 patients,48 suffered from ipsilateral re-herniation,and 8 suffered from contralateral re-herniation. All the patients had a mean pain-free interval of 5.5 years（range,6 months to 27 years）. The visual analogue scale（VAS） score for back pain was 6.18±1.44 and the VAS score for leg pain was 7.66±1.03. Postoperative effectiveness was assessed based on the VAS score and modified Mac Nab criteria. Results The mean operation time was 60.4 minutes（range,30-100 minutes） and the mean duration of hospital stay was 5.1 days（range,3-6 days）. All patients were followed up 28.2 months on average（range,24-56 months）. Patients obtained immediate pain relief postoperatively. The postoperative VAS scores of back and leg pain at 1 month,3 months,12 months,and last follow-up were significantly decreased when compared with preoperative score（P〈0.05）. Based on the modified Mac Nab criteria,the results were excellent in 39 cases,good in 9 cases,fair in 5 cases,and poor in 3 cases at 12 months after operation,and the excellent and good rate was 85.7%. Surgery-related complications were found in 5 cases（8.9%）; one patient（1.8%） suffered from recurrence at 18 months postoperatively,and the symptom was relieved after open lumbar discectomy and intervertebral fusion surgery. Conclusion PETD has several advantages in treating RLDH,such as avoiding from the old scar tissue,decreasing operation-related complications,shortening operation time,reducing trauma,and obtaining rapid postoperative recovery. This technique is feasible and effective for RLDH.

关 键 词：复发性腰椎间盘突出症 经皮内镜腰椎间盘髓核摘除术 椎间孔入路 微创技术 

分 类 号：R687.3[医药卫生—骨科学]