经皮椎间孔镜治疗L4-L5和L5-S1腰椎间盘突出症的效果比较  

Comparative study of percutaneous endoscopic lumbar discectomy on L4-L5 and L5-S1 lumbar disc herniation

作　　者：陈敬忠[1] 张东[1] 肖伟[1] 方凯[1] 黄飞[1] Chen Jingzhong;Zhang Dong;Xiao Wei;Fang Kai;Huang Fei(Department of Orthopedics,the Second People＇s Hospital of Neijiang,Neijiang 641000,China)

机构地区：[1]四川省内江市第二人民医院骨科,641000

出　　处：《临床医学》2018年第10期16-18,22,共4页Clinical Medicine

摘　　要：目的对比经皮椎间孔镜治疗第4～5腰椎(L4～L5)和第5腰椎～第1骶椎(L5～S1)腰椎间盘突出症的效果。方法随机选取2016年6月至2017年5月行经皮椎间孔镜治疗的L4～L5和L5～S1腰椎间盘突出症患者50例,回顾性分析其临床资料。其中L4～L5腰椎间盘病变者28例,L5～S1腰椎间盘病变者22例。比较L5～S1与L4～L5椎间盘病变者手术时间、术中透视时间、术后(1、3、6个月及1年)疼痛视觉模拟评分(VAS)、术后1年Oswestry功能障碍指数(ODI)及其疗效。结果 L5～S1椎间盘病变者手术时间和透视时间长于L4～L5椎间盘病变者(P <0. 05)。L5～S1与L4～L5椎间盘病变者术前VAS评分以及ODI指数、术后(1、3、6个月及1年) VAS评分、术后1年ODI指数比较,差异均未见统计学意义(P>0. 05)。L5～S1与L4～L5椎间盘病变者术后1年疗效比较,差异未见统计学意义(P>0. 05)。结论经皮椎间孔镜治疗L4～L5和L5～S1腰椎间盘突出症均能取得较为理想的效果,但L5～S1腰椎间盘病变者手术操作难度较大,手术操作熟练者可减少手术时间及术中透视时间。Objective To compare the effects of percutaneous endoscopic lumbar discectomy on L4-L5 and L5-S1 lumbar disc herniation. Methods Fifty patients with L4-L5 and L5-S1 lumbar disc herniationunderwentpercutaneous endoscopic lumbar discectomy from Jun 2016 to May 2017 were prospectively collected. In which,there were 28 cases of the L4-L5 segment lesions,and 22 cases of the L5-S1 segment lesions. The operation time,radiation exposure time,visual analogue scale（ VAS）score,Oswestry disability index（ ODI）,MacNab at preoperation and the 1-year follow-up were evaluated and compared between the two groups. Results The operation time,radiation exposure time in paitents with L5-S1 segment lesions were longer than those in the paitents with L4-L5,and the difference was significant（ P〈0. 05）. There was no significant difference in the length of stay and the recovery time between the two groups（ P〉0. 05）. There was no significant difference in VAS scores between the two kinds of patients at 1 month,3 months,6 months,and 1 year after the operation（ P〉0. 05）. There was no significant difference in the ODI and Mac Nab between the two groups（ P〉0. 05）. Conclusions Excellent clinical effect can be obtained in percutaneous endoscopic lumbar discectomy for both L4-L5 and L5-S1 lumbar disc herniation. However,the operation of L4-S1 lumbar intervertebral dlisc lesions is more difficult,and skilled doctors can shorter theoperaton time.

关 键 词：经皮椎间孔镜 腰椎间盘突出 

分 类 号：R687.3[医药卫生—骨科学]