经皮全内镜微创治疗游离型腰椎间盘突出症  

Percutaneous full-endoscopic spine technique for dissociative lumbar disc herniation

作　　者：邹欣欣[1] 李超[1] 于海洋[1] 付青松[1] 梁成民[1] 焦伟[1] 翟云雷[1] 李海江[1] ZOU Xin-xin;LI Chao;YU Hai-yang(Department of Orthopaedics,People＇s Hospital of Fuyang,Fuyang,Anhui 236001,China)

机构地区：[1]阜阳市人民医院骨科,安徽阜阳236001

出　　处：《颈腰痛杂志》2018年第5期600-602,共3页The Journal of Cervicodynia and Lumbodynia

摘　　要：目的分析经皮椎间孔入路(percutaneous endoscopic transforaminal discectomy,PETD)与经皮椎板间入路(percutaneous endoscopic interlaminar discectomy,PEID)全内镜技术治疗游离型腰椎间盘突出症的策略及疗效。方法回顾分析我院2013-07-2017-07采用经皮全内镜下治疗游离型腰椎间盘突出症47例患者资料,其中采用PETD 31例,PEID 16例;突出节段L3-43例、L4-529例、L5-S115例;游离间盘按Lee分区:I区6例,II区9例、III区19例、IV区13例。结果平均手术时间为137 min。术后短期大腿前方麻木2例、硬脊膜损伤1例、行走神经根损伤1例,经保守治疗后均明显改善。术后第1天和12个月的腰痛、腿痛VAS评分、Oswestry功能障碍指数(ODI)均较术前显著改善(P<0.01);按MacNab疗效评价,优33例、良8例、可3例、差3例,优良率87.2%。结论经皮椎间孔镜技术治疗游离型腰椎间盘突出症可获得良好的疗效,对于L5-S1腰椎间盘突出症采用PEID更具有优势。Objective To analyze the effect of percutaneous endoscopic transforaminaldiscectomy （PETD） and percutaneous endoscopic interlaminar discectomy （PEID） in the treatment ofdissociative lumbar disc herniation. Methods From July 2013 to July 2017, 47 cases of free lumbardisc herniation were treated by percutaneous endoscopic ultrasonography. Among them, 31 cases weretreated by percutaneous transforaminal approach, 16 cases were treated by percutaneous interlaminarapproach. There were 35 males and 12 females, with an average age of 43 years old. There were 3cases of L3-4, 29 cases of L4-5, and 13 cases of L5-S1. According to Lee classification, there were 9cases of Ⅱ zone, 6 cases of Ⅰ zone, 19 cases of Ⅲ zone and 13 cases of Ⅳ zone. Results The averageoperation time was 137 min. After operation, there were 2 cases of numbness in front of thigh, 1 caseof dura mater injury, 1 case of nerve root injury, and the others were with no direct complication. TheVAS pain score, JOA score, Oswestry （ODI） index of lumbar and legs at the first day and 12 monthsafter surgery were improved （P〈0.01）. According to MacNab criteria, 33 cases of excellent, good in 8cases, 3 cases in fair and 3 cases in poor, the excellent rate was 87.2%. Conclusion PETD iseffective in the treatment of free lumbar disc herniation. PEID approach is a better choice for L5-S1free lumbar disc herniation.

关 键 词：游离型腰椎椎间盘突出 脊柱内镜 脊柱手术 微创 

分 类 号：R687.3[医药卫生—骨科学]