使用椎间孔镜治疗极外侧型腰椎间盘突出症的临床研究  

Clinical study of percutaneous transforaminal endoscopic discectomy for far lateral lumbar disc herniation

作　　者：王彦东 马瑞[2] 钱济先[3] 周勇[3] 张伟 杨智泉 韩康[4] 党培业 

机构地区：[1]榆林市星元医院(榆林市第四医院)骨2科,陕西榆林719000 [2]榆林市第二医院核磁共振室,陕西榆林719000 [3]第四军医大学唐都医院全军骨科中心,陕西西安710038 [4]济南军区总医院脊髓修复科,山东济南250000

出　　处：《中华全科医学》2017年第7期1099-1101,1108,共4页Chinese Journal of General Practice

基　　金：国家自然科学基金(81272441);济南军区总医院院长基金项目(2015ZX01)

摘　　要：目的腰椎间盘突出症是目前的常见脊柱疾病。极外侧型腰椎间盘突出症是其中的一种特殊的类型,其诊断与治疗与常规腰椎间盘突出症类型均有较大的差异。本文拟探讨和总结使用椎间孔镜治疗极外侧型腰椎间盘突出症的临床效果和安全性。方法对2013年9月—2015年9月榆林市星元医院明确诊断为极外侧型腰椎间盘突出并行手术治疗的43例患者进行回顾性分析。所有患者经统一的纳入及排除标准筛选后,按照治疗方法的不同,分别纳入实验组(椎间孔镜组:25例)与对照组(常规开放手术治疗组:18例)。每个患者均接受了至少6个月的术后随访。在手术前后对患者的疼痛改善、腰椎功能恢复等指标进行观察和比较。并对2组患者的手术时间、出血量、花费、卧床时间、并发症等指标进行记录和比较。结果实验组与对照组患者术后的疼痛指标(VAS)及腰椎功能指标(lehmann)较手术前均有显著的改善(P<0.05),但2组患者在术后疼痛及腰椎功能改善的比较中差异无统计学意义(P>0.05)。但实验组手术时间、出血量、住院时间、并发症等围手术期等指标都显著优于对照组(P<0.05),从而显示实验组较对照组出血量更少,手术时间及住院时间更短,并发症更少。结论椎间孔镜技术在极外侧型腰椎间盘突出症的外科手术治疗中,能够显示其独有的特点和优势,在临床工作中可以进行进一步的使用和推广。Objective Lumbar disc herniation is the common spinal disease. The far lateral lumbar disc herniation is a special type, which of the diagnosis and treatment are different from that of the conventional lumbar disc herniation. The aim of this paper is to observe the clinical effect and safety of percutaneous endoscopic lumbar discectomy（PELD） in patients with far lateral lumbar disc herniation. Methods The clinical and follow-up data of 43 patients who were admitted in our hospital from September,2013 to September, 2015 and diagnosed as far lateral lumbar disc herniation undergoing surgery therapy were retrospectively analyzed. The patients were divided into experimental group（ PELD：n = 25 ） and control group （tradition open-operation：n = 18） and followed up at least 6 months after the treatment. The clinical outcomes were evaluated by visual analogue scale （VAS） and Lehmann Lumbar function score, operation time, the time in bed, blood loss, cost and complications and so on. Results There were significant difference in the VAS and lumbar function in two groups comparing that before the operation （ P 〈 0.05 ）, while there was no difference between two groups in the VAS score and lumbar function after the operation（ P 〉 0.05 ）. The operation time, the time in bed, blood loss, cost and complications who had PELD was significantly better compared with those in control group （ P 〈 0.05 ） , which shows that the patients in PELD group has less blood loss, shorter operation and hospital time and more safe complication. Conclusion PELD for far lateral lumbar disc herniation h.as more particular advantages than normal treatments, which should be further application and promotion in clinic.

关 键 词：腰椎间盘突出症 椎间孔镜 疼痛 

分 类 号：R681.53[医药卫生—骨科学] R687.4[医药卫生—外科学]