靶向椎间孔成形减压术治疗游离型腰椎间盘突出合并神经根管狭窄症  

Targeted decompression via foraminoplasty for treatment of free lumbar disc herniation complicated with nerve root canal stenosis

作　　者：吴蕾蕾 冷辉[2] 贾一明[2] 吴景山[2] Lei-lei Wu;Hui Leng;Yi-ming Jia;Jing-shan Wu(Postgraduate College,Inner Mongolia Medical University,Huhehaote,Inner Mongolia 010000,China;Department of Spine Surgery,Chifeng Hospital,Chifeng,Inner Mongolia 024000,China)

机构地区：[1]内蒙古医科大学研究生院,内蒙古呼和浩特010000 [2]内蒙古自治区赤峰市医院脊柱外科,内蒙古赤峰024000

出　　处：《中国内镜杂志》2018年第10期53-59,共7页China Journal of Endoscopy

摘　　要：目的探讨经皮椎间孔镜下行靶向椎间孔成形减压术治疗游离型腰椎间盘突出合并神经根管狭窄症的临床疗效。方法选取2016年10月-2017年12月赤峰市医院脊柱外科收治的30例游离型腰椎间盘突出合并神经根管狭窄症患者。所有患者均在经皮椎间孔镜下行靶向椎间孔成形减压术。记录术前1 d、术后2 d及术后3个月患者腰痛与腿痛视觉模拟评分(VAS)和Oswestry功能障碍指数(ODI),术后2 d及术后3个月采用改良Macnab标准评估手术疗效。结果所有患者均顺利完成治疗,手术时间为65~200 min,平均90 min。术中出血量为15~135 ml,平均55 ml。卧床时间均不超过24 h,平均住院日为5 d。术前1 d腰痛及腿痛VAS评分为(6.57±1.96)和(7.03±1.75)分,术后第2天腰痛及腿痛VAS评分为(2.03±0.96)和(1.97±1.07)分,术后3个月腰痛及腿痛VAS评分为(1.83±0.95)和(1.77±1.04)分,术前1 d、术后2 d及术后3个月ODI指数分别为(70.42±3.55)%、(22.56±0.72)%和(22.69±0.70)%。可以看出术后3个月和术后2 d较术前1 d各项指标均有改善,差异有统计学意义(P <0.05)。应用改良Macnab标准评定疗效,在临床疗效上,术后3个月患者的优良率为96.67%。明显优于术后2 d的优良率73.33%,两组比较差异有统计学意义(P <0.05)。结论经皮椎间孔镜下靶向椎间孔成形减压术是治疗游离型腰椎间盘突出合并神经根管狭窄症的微创、有效、安全的手术方式之一。Objective To analyze the clinical efficacy of targeted decompression via foraminoplasty for treatment of free lumbar disc herniation complicated with nerve root canal stenosis.Methods A retrospective analysis was performed on 30 cases of free lumbar disc herniation and nerve root canal stenosis,all of them were treated with targeted decompression via foraminoplasty from October 2016 to December 2017.The visual analogue scale(VAS)score of waist pain and leg pain at 1 day before preoperation and 2 days,3 months after postoperation were recorded,and the modified Macnab criteria was used to evaluate the effectiveness at 2 days,3 months after postoperation.Results All the 30 patients underwent operation successfully.The operation time was 65~200 min,with an average of 90 min.Intraoperative blood loss was 15~35 ml,with an average of 25 ml.Bedtime is not more than 24 h,the average length of stay for 5 d.1 day before preoperation,the VAS scores of waist pain and leg pain were(6.57±1.96),(7.03±1.75)points;2 days after postoperation,the VAS scores of waist pain and leg pain were(2.03±0.96),(1.97±1.07)points;3 months after postoperation,the VAS scores of waist pain and leg pain were(1.83±0.95),(1.77±1.04)points.1 day before preoperation,2 days and 3 months after postoperation,ODI were respectively(70.42±3.55)%,(22.56±0.72)%,(22.69±0.70)%.It can be seen 3 months after postoperation compared with 1 day before preoperative and 2 days after postoperation,all the indexes were improved,the difference was statistically significant(P<0.05).the modified Macnab criteria was used to evaluate the effectiveness.In terms of clinical,3 months after postoperation patients has a high rate of 96.67%,much better than 2 days after postoperation patients with73.33%,two sets of contrasting differences,statistically significant(P<0.05).Conclusions Percutaneous transforaminal endoscopic targeted decompression via foraminoplasty is a kind of minimally invasive,safe and effective treatment for the free lumbar disc herniation complicated wit

关 键 词：靶向 神经根管狭窄 游离型腰椎间盘突出症 椎间孔成形 

分 类 号：R681.53[医药卫生—骨科学]