完全内窥镜下手术治疗腰椎间盘突出症早期疗效观察  

Early clinical efficacy of surgical treatment for lumbar disc herniation with full-endscopic

作　　者：丁华[1] 章洪喜[1] 袁即山[1] 潘展鹏[1] 刘涛[1] 万博文 周辉辉[1] 

机构地区：[1]江苏大学附属人民医院骨二科,江苏镇江212002

出　　处：《临床骨科杂志》2017年第1期9-12,共4页Journal of Clinical Orthopaedics

摘　　要：目的评价完全内窥镜下手术治疗腰椎间盘突出症的早期临床疗效。方法采用完全内窥镜技术治疗60例腰椎间盘突出症患者(62个退变椎间盘),术前、术后1 d及1、3、6个月记录患者腰腿痛VAS评分,术后6个月采用改良MacNab评价疗效。结果患者均顺利完成手术。手术时间0.5~2.5 h,术中出血量2~10ml,术后住院时间1~7 d。未发生椎间隙感染、神经根损伤、腹腔脏器及大血管损伤等严重并发症。1例术中硬脊膜损伤,保守治疗1周后症状消失;2例发生下肢麻木加重,经治疗后1个月内症状消失;1例钙化型腰椎间盘突出症术后腰腿痛无明显缓解,术后2个月行后路椎板间开窗减压髓核摘除术后疼痛明显好转。患者均获得随访,时间8个月~2年。腰腿痛VAS评分术后1d及1、3、6个月与术前比较差异均有统计学意义(P<0.05)。术后6个月采用改良MacNab评定疗效:优47例,良8例,可4例,差1例,优良率91.7%。结论完全内窥镜技术能有效治疗腰椎间盘突出症,是椎间盘突出症阶梯治疗中的重要手段,早期效果满意,远期疗效有待进一步观察。Objective To evaluate early clinical efficacy of surgical treatment for lumbar disc herniation with fullendscopic. Methods Full-endscopic technology was applied in the treatment of 60 cases of lumbar disc herniation（ 62 degenerated intervertebral disc）. The assessment was performed by using VAS at preoperation,1 day and 1,3,6months after the operation. At 6 months after the operation,improved Mac Nab criterion was used to evaluate the curative effects. Results All patients were successfully operated. The operation time was 0. 5 - 2. 5 h. Bleeding during operation was 2 - 10 ml. The postoperative hospital stay was 1 - 7 d. Serious complications such as intervertebral space infection,nerve root injury,abdominal organs and large vessel injury didn＇t occur. One case of intraoperative spinal dura mater was injury,1 week after the conservative treatment,dizziness symptom disappeared. Two cases of lower limbs numbness aggravated,being treated by Methycobal treatment,the symptoms disappeared 1 month after surgery during the follow-up. One case of calcified lumbar disc herniation patient,postoperative low back and leg pain had no obvious relief. The postoperative pain was significantly relieved after the operation of posterior decompression and decompression of the nucleus pulposus. The patients were followed up from 8 months to 2 years. Low back and leg pain VAS had statistical significance especially at the time point of 1 d and 1,3,6 months after the operation（ P〈0.05）. Evaluation efficacy of improved Mac Nab criterion 6 months after operation： excellent in 47 cases,good in 8cases,fair in 4 cases and poor in 1 case,the excellent and good rate was 91. 7%. Conclusions Full-endscopic technology can be effective in the treatment of lumbar disc herniation,it is an important means in the treatment of lumbar disc herniation,the early results are satisfactory,but long-term results are needed to be further confirmed.

关 键 词：腰椎间盘突出症 椎间盘切除术 经皮 内窥镜检查 

分 类 号：R681.5[医药卫生—骨科学] R687.3[医药卫生—外科学]