经皮内窥镜下腰椎间盘摘除术失败原因分析  

Failure Cause Analysis of Percutaneous Endoscopic Lumbar Discectomy

作　　者：王永福[1] 何友智[1] 王上元[1] 许宇霞[1] 

机构地区：[1]湖南省长沙市中心医院脊柱外科,湖南长沙410000

出　　处：《实用骨科杂志》2017年第3期217-220,共4页Journal of Practical Orthopaedics

摘　　要：目的分析经皮内窥镜下腰椎间盘摘除术的失败原因。方法 2010年2月至2014年2月,采用经皮内窥镜下腰椎间盘摘除术治疗患者421例,其中男279例,女142例;年龄21~59岁,平均39.7岁。腰椎间盘突出节段位于L3~413例,L4~5319例,L5S189例。记录手术时间、住院天数、术后并发症、临床疗效(改良Macnab标准)、经皮内窥镜下腰椎间盘摘除术(percutaneous endoscopic lumbar discectomy,PELD)失败率及复发率。结果随访时间12~56个月,平均31.6个月。手术时间30~100min,平均58.4min;住院时间2~5d,平均3.4d;临床疗效优良率90.3%;PELD失败率4.3%(18/421);复发率0.7%(3/421)。18例失败病例中,椎间盘摘除不完全者12例(66.7%),复发者3例(16.7%),术后顽固性疼痛者2例(11.1%),神经根损伤者1例(5.6%)。12例椎间盘摘除不完全者中,工作通道位置不适宜者4例(33.3%),游离型者3例(25.0%),中央型椎间盘突出者3例(25.0%),腋下型者3例(25.0%),肩型者1例(8.3%)。其中游离型者中有2例工作通道位置不适宜,腋下型和肩型者各有1例工作通道位置不适宜。2例顽固性疼痛者,经MRI及CT检查示椎间盘摘除完全,但是有侧隐窝狭窄。结论经皮内窥镜下腰椎间盘摘除术能够获得满意的临床疗效,但要想成功的实施PELD术,仍需要根据椎间盘突出类型进行个体化对待、精确的工作通道置入和手术经验的积累。Objective To analyze the failure cause analysis of percutaneous endoscopic lumbar discectomy （PELD）. Methods From February 2010 to February 2014,421 patients had undergone PELD.The operation time,length of stay,postoperative complications,clinical outcomes （using modified Macnab criteria）,failure rate of PELD and rate of recurrence were collected.Results The follow-up time was 12~56 months with a mean of 31 .6 months.Operative time was 30~100 mins a mean of 58.4 mins;hospitalization time was 2~5 days a mean of 3.4 days;the rate of good-to-ex-cellent was 90.3%;the failure rate of PELD was 4.3% （18/421）;the rate of recurrence was 0.7% （3/421）.The reasons of failure showed as following：incomplete removal of herniated disc material in 12 patients （66.7%）,recurrence in 3 （16.7%）patients,postoperative persistent pain in 2 patients （11.1%）,nerve root injury in 1 patient （5.6%）.The rea-sons of incomplete removal of herniated disc material as following：technically inappropriate positioning of the working channel in 4 patients （33.3%）,migrated discs herniation in 3 patients （25.0%）,central disc in 3 patients （25.0%）,axil-lary type in 3 patients （25.0%）,and shoulder type in 1 patient （8.3%）.Two patients with persistent pain,the MRI and CT examination showeds that they were associated with lateral recess stenosis.Conclusion PELD can achieve a satis-factory clinical outcomes,however,successful PELD requires techniques to remove the herniated disc fragments in vari-ous types of disc herniations,the accumulation of surgical experience and precise placement of the working channel.

关 键 词：腰椎间盘突出症 经皮内窥镜椎间盘摘除 疗效 

分 类 号：R681.53[医药卫生—骨科学]