硬膜外游离型腰椎间盘突出症的手术方式探讨  

PELD versus FD for epidural sequestered lumbar disc herniation

作　　者：耿晓鹏[1] 高升[1] 王霞[2] 李建军[1] 李雪城 付国勇[1] 房清敏[1] 孙兆忠[1] 

机构地区：[1]滨州医学院附属医院,山东滨州256603 [2]山东滨州市人民医院,256610

出　　处：《中国矫形外科杂志》2017年第7期605-611,共7页Orthopedic Journal of China

基　　金：山东省医药卫生科技发展计划项目(编号:2013WS0300)

摘　　要：[目的]依据游离髓核位置的分型与分区,探讨摘除硬膜外游离椎间盘的手术方式并评估经皮内窥镜下腰椎间盘切除术(PELD)、椎板开窗髓核摘除术(FD)治疗硬膜外游离型腰椎间盘突出症的手术疗效。[方法]回顾性分析本科2013年8月~2015年3月收治的此类患者37例,FD组:16例,其中5例髓核游离于1、4区的患者采用扩大开窗髓核摘除术;11例2、3区的患者采用常规FD手术。PELD组:共21例,其中4例髓核游离于1、4区的患者采用经对侧椎间孔镜腰椎间盘切除术(c-PTED);17例2、3区的患者应用了常规的经同侧椎间孔镜腰椎间盘切除术(i-PTED)。采用视觉模拟量表(VAS)评分、改良Macnab分级标准、Oswestry功能障碍指数(ODI)评定手术疗效,统计并比较两组在手术时间、出血量及术后住院时间上的差异。[结果]两组患者均得到完整随访,随访时间15~18个月,平均16.3个月。术后下肢疼痛VAS评分及ODI评分均较术前明显改善(P<0.05),但术后两组间VAS评分及ODI评分差异无统计学意义(P>0.05)。依据末次随访疗效,按照改良Macnab标准评定,PELD组优良率95.2%,FD组优良率87.5%,差异无统计学意义(P>0.05)。PELD组与FD组相比,手术时间较长、出血量少、术后住院时间短,差异有统计学意义(P<0.05)。[结论]针对硬膜外游离腰椎间盘突出症,依据其特有分型与分区恰当选用i-PTED及c-PTED可实现神经根的彻底减压,获得与FD手术相同疗效,扩大了PELD治疗腰椎间盘突出症的手术适应证。同时,相对于FD手术,PELD可在局麻下以更加安全、创伤更小的方式摘除游离于硬膜外的椎间盘组织。[Objective ] To evaluate and compare the clinical outcomes of pereutaneous endoscopic, lumhar discectomy （PELD） and fenestratinn discectomy （FD） for epidural sequestered lumhar disc herniation. [Methods] Between August 2013 and Mareh 2015, 37 patients received PELD or FD surgery. There were 16 patients iu FD group, including 5 cases of nucleus in zone 1 amt zone 4 receiving extended FD, 11 cases of nucleus in zone 2 amt zone 3 reeeiving conventional FD. Another 21 cases were in PE1,D group, including 4 cases of nucleus in zone 1 and zone 4, who were treated by pereutaneous transforaminal endoscopic discectomy via a contralateral apprnach （c-PTED）, and 17 cases of nucleus in zone 2 and zone 3, who were treated by eonventinnal pereutaneous transfi）raminal endoscopic discectomy via ipsilateral transforaminal approach （i-PTED） . The surgical outeome were evaluated by visual analog scale （VAS） score, modified MacNab grading criteria and Oswestry disability index （OD]） . The operation time, blood loss volume, postoperative hospital stay of patients in two grnups were recorded and analyzed respectively. [Results] All patients were followed up fi）r 15- 18 months （mean 16.3 months） . After the operation, lower limb pain VAS score and ODI seore in both two groups improved signifieantly than preoperative ones, the difference was statistically significant （P〈0.05） . But no significant difference was found between the two groups （P〉0.05） . At the final follow-up, 95.2% excellent and good outcomes had been achieved in the PELD group and in the FD group, only 87.5% , but no significant difference （P〉0.05） was found between the two groups according to MaeNab criteria score. Furthermore, PELD group had longer operative time than FD group （P〉0.05） , but lesser blood loss volume and postoperative hospital stay, with statistically significant difference （P〈0.05） . [Conclusions] Compared with FD, i-PTED or c-FTED can achieve complete decompression of the nerve root in a mo

关 键 词：硬膜外游离腰椎间盘突出症 分型 分区 椎间孔镜 椎板开窗 

分 类 号：R687.3[医药卫生—骨科学]