显微镜辅助下固定通道手术治疗腰椎间盘突出症的临床疗效分析  

Clinical analysis of surgical treatment of lumbar disc herniation by microscope combined with fixed channel

作　　者：刘阳[1] 姜畅[1] 杨群[1] 马凯[1] 李利南[1] 王博[1] 杨军[1] Liu Yang;Jiang Chang;Yang Qun;Ma Kai;Li Linan;Wang Bo;Yang Jun(Department of Spine Surgery,the First Affiliated Hospital of Dalian Medical University,Dalian 116011,China)

机构地区：[1]大连医科大学附属第一医院脊柱外科,大连116011

出　　处：《中华解剖与临床杂志》2018年第3期219-222,共4页Chinese Journal of Anatomy and Clinics

摘　　要：目的探讨显微镜辅助下经固定通道手术治疗腰椎间盘突出症的临床疗效及可行性。方法回顾性分析2015年3月-2016年3月大连医科大学附属第一医院脊柱外科手术治疗的43例腰椎问盘突出症患者的临床资料。其中男25例、女18例，年龄28-77（46．49±6．60）岁；病变节段L2/3例，L4/5 244例，L5／S116例。保守治疗效果不佳后均采用显微镜辅助下固定通道手术治疗。通过观察术前、术后3个月和末次随访腿疼痛视觉模拟评分（VAS）及Oswestry功能障碍指数（ODI）对手术效果进行评价。末次随访时应用改良MacNab评定标准进行治疗效果判定。结果43例患者术后均获得随访，随访时间10～18（14．49±1．98）个月，无脑脊液漏、感染、神经根损伤等并发症。按照改良MacNab评定标准，本组疗效优16例、良23例、可4例，优良率为90．7％（39／43）。术后3个月和末次随访VAS及ODI与术前比较，差异均有统计学意义（P值均〈0．01），而术后3个月与末次随访时比较差异均无统计学意义（P值均〉0．05）。结论显微镜辅助下固定通道手术治疗腰椎间盘突出症术后疗效满意，是治疗腰椎间盘突出症的一种可行且有效的手术方法。Objective To analyze the clinical effects of surgery treatment for herniated lumbar disc assisted by microscope combined with fixed channel. Methods The clinical data of 43 patients with herniated lumbar disc who received surgery assisted by microscope combined with fixed channel in the First Affiliated Hospital of Dalian Medical University from March 2015 to March 2016 were retrospectively reviewed, including 25 males and 18 females with an age of 28-77 （46.49 ±6.60） years. Among them, the lesion spine level was located at L2/3 segment in 3 patients, L4/5 segment in 24 patients and L5/S1 segment in 16 patients. Due to the effect of conservative treatment was not satisfactory, the microscope together with a fixed channel was applied to assist in surgery. The surgical outcomes were evaluated by leg visual analogue score（VAS） and Oswestry disability index（ODI） before and 3 months after operation and last follow-up. At the last follow-up, the modified Macnab criteria were used to evaluate the excellent rate and determine the treatment effect. Results All the 43 patients were followed up, and the follow-up time was 10-18 （14.49±1.98 ） months. No complications such as cerebrospinal fluid leakage, infection and nerve root injury occurred. According to modified Macnab criteria, the efficacy was excellent in 16 patients, good in 23 patients, general in 4 patients, with the rate of being excellent and good of 90.7% （39/43）. The difference of VAS scores and ODI scores before operation and 3 months after operation, last follow-up were statistically significant （ all P values 〈0.01 ）, but there were no significant differences in both variables between the last follow-up and 3 months after operation （ all P values 〉 0.05 ）. Conclusions It is an effective and feasible procedure for surgery assisted by microscope combined with fixed channel in the treatment of lumbar disc herniation, which has satisfactory efficacy.

关 键 词：椎间盘移位 腰椎 显微外科手术 通道 

分 类 号：R687.3[医药卫生—骨科学]