经皮椎间孔镜靶向穿刺分步法治疗腰椎间盘突出症效果分析  

The effect of percutaneous transforaminal endoscopic discectomy via target puncture and 2-stage procedures in treatment of lumbar disc hernia

作　　者：田永刚[1] 王铜浩[1] 韩立强[1] 江汉[1] 江毅[1] 肖联平[1] 

机构地区：[1]天津市第三中心医院脊柱外科、天津市人工细胞重点实验室,300170

出　　处：《天津医药》2015年第8期905-908,共4页Tianjin Medical Journal

摘　　要：目的探讨经皮椎间孔镜靶向穿刺分步法治疗腰椎间盘突出症的临床疗效。方法选取我院2014年1—6月经皮椎间孔镜技术治疗腰椎间盘突出症患者36例,采用视觉模拟评分法(VAS)评价手术前后的腰痛和下肢痛,Oswestry功能障碍指数(ODI)及Mac Nab标准评估手术效果。结果所有患者均顺利完成手术。手术时间(125±31)min,术中出血(8.5±2.9)m L,平均住院时间(7.6±3.5)d。出院时及末次随访腰痛、下肢痛VAS评分均低于术前,末次随访时的ODI(73.30±18.21)%高于术前(18.90±7.78)%,差异均有统计学意义。Mac Nab疗效评定优良率94.4%。1例术后出现了L4神经根支配区的痛觉过敏,经保守治疗后好转,无神经损伤、脑脊液漏、感染等并发症。其余患者随访期间疗效稳定,无间盘突出复发。结论靶向穿刺结合分步法经皮腰椎间盘摘除术可摘除突出及间隙内间盘组织,达到充分减压并防止复发的目的,具有微创、安全、康复快、住院时间短等优点。Objective To evaluate the effect of percutaneous transforaminal endoscopic discectomy （PTED） using target puncture and 2-stage procedures in treating lumbar disc hernia. Methods Patients present in our clinic from January 2014 to June 2014 with lumbar disc hernia who were treated with PTED were collected （n=36）. Lower back and leg pain were evaluated by visual analog scale （VAS） while clinic outcome were assessed by Oswestry disability index （ODI） and modified Macnab criteria. Results All surgeries were carried out successfully. On average, operation time was（125±31）min, blood loss was（8.5±2.9）mL in each operation. The average length in hospital stay was（7.6±3.5）day. Compared with the preoperative VAS scores,the postoperative and last follow-up scores for lower back and leg pain decreased significantly （P〈0.01）. The ODI of pre-operation and last follow-up were （18.90 ± 7.78）%and （73.30 ± 18.21）%respectively with statistic difference. As to the modified Macnab criteria,the＂excellent and good＂ratio was 94.4%. One case present hyperalgesia in L4 dermatome which recovered through conservative treatment. No complications such as permanent nerve root injury ,cerebrospinal fluid leakage,or infection were found during or after operations. All patients are in stable conditions during follow-up period without recurrence. Conclusion PTED using target puncture and 2-stage procedures is an effective method with minimal trauma, less bleeding, quick recovery, high security, short hospitalization time. what′s more, it can remove protruded disc and broken nucleus from the intervertebral space. It ensure efficacy and avoid recurrence.

关 键 词：椎间盘移位 外科手术 微创性 经皮椎间孔镜腰椎间盘摘除术 

分 类 号：R681.57[医药卫生—骨科学]