椎间盘镜联合射频消融术治疗多节段腰椎间盘突出症  

Microendoscopic Discectomy Combined with Radiofrequency Ablation for Multi-segmental Lumbar Disc Herniation

作　　者：程昌志[1] 李贵谦[1] 董兴成[1] 林舟丹[1] CHENG Chang-zhi;LI Gui-qian;DONG Xing-cheng;LIN Zhou-dan(Department of Orthopedics, The 923rd Hospital of Chinese People' s Liberation Army, Nanning 530021, Guangxi, China)

机构地区：[1]中国人民解放军第923医院骨科,广西南宁530021

出　　处：《中国现代手术学杂志》2019年第1期50-53,共4页Chinese Journal of Modern Operative Surgery

摘　　要：目的探讨后路椎间盘镜(MED)联合射频消融术治疗多节段腰椎间盘突出症的疗效。方法回顾性分析2011年10月～2015年10月我院治疗的多节段(两节及两节以上)单纯腰椎间盘突出症22例患者的临床资料,其中受累椎间盘:L4/5、L5/S1 17例,L3/4、L4/5 2例,L3/4、L4/5、L5S1 3例。对主要突出节段采用后路椎间盘镜进行髓核摘除术,对次要突出节段采用射频消融术治疗:L4/5射频消融+L5S1 MED 13例,L5S1射频消融+L4/5 MED 4例,L4/5射频消融+L3/4椎间盘镜1例, L3/4射频消融+L4/5椎间盘镜1例, L3/4、 L4/5射频消融+L5S1 MED 3例。记录手术时间、术中出血量,比较手术前后腰腿痛VAS评分、JOA评分。结果本组所有患者均顺利完成手术,手术时间平均90(70～210)分,出血平均145.8(50～300)ml。所有手术切口均一期愈合,无伤口感染、血肿形成、神经损伤、硬膜囊破裂等并发症。1例患者下肢仍有中等麻痛、 2例足趾轻度麻木,其余患者基本恢复。平均随访18.2(12～27)月,无一例复发,复查MRI示消融椎间盘无退变及突出进展。术后1周和末次随访JOA评分分别为(18.0±3.11)分和(25.18±2.92)分,均较术前(9.09±0.97)分明显改善(P<0.01);术后1周和末次随访VAS评分分别为(3.00±0.87)分和(2.23±0.92)分,均较术(7.86±0.94)前明显降低(P<0.01)。结论对多节段腰椎间盘突出症,后路椎间盘镜联合射频消融术能即刻解除突出椎间盘导致的神经压迫,减轻邻近次要突出椎间盘的压力,减缓邻近椎间盘突出进展。Objective To discuss the effect of posterior microendoscopic discectomy(MED) combined with radiofrequency ablation(RA) in the treatment of multi-segmental lumbar disc herniation. Methods The clinical data of 22 patients with multi-segmental(two or more segments) lumbar disc herniation treated in our hospital from October 2011 to October 2015 were analyzed retrospectively, including L4/5 and L5/S1 involved in 17 cases, L3/4 and L4/5 in 2 cases, and L3/4, L4/5 and L5 S1 in 3 cases. MED was performed on the main herniated segments of disc, and RA was on the minor herniated segments of disc: L4/5 RA combined L5 S1 MED in 13 cases, L5 S1 RA combined L4/5 MED in 4 cases, L4/5 RA combined L3/4 MED in 1 case, L3/4 RA combined L4/5 MED in 1 case, and L3/4, L4/5 RA combined L5 S1 MED in 3 cases. The operation time and intra-operative bleeding volume were recorded, and the VAS score and JOA score was compared between before and after the operation. Results The surgery was accomplished in all cases, and the bleeding volume was 50 to 300 ml(mean, 145.8) and the operative duration was 70 to 210 min(average, 90). All incisions achieved healed at one stage without complications such as wound infection, hematoma formation, nerve injury and dural sac rupture. Except for 1 patient with moderate pain in lower limbs and 2 patients with slight numbness in toes,the rest of the patients recovered basically. All cases were followed up for 18. 2 months( ranged from 12 to 27). There was no recurrence,degeneration and protrusion of the disc. The JOA score of 1 week and the last follow-up was 18.0± 3.11 and 25.18± 2.92 respectively,and both were improved significantly than 9.09±0.97 of pre-operation( P<0.01). The VAS score of 1 week and the last follow-up was 3.00±0.87 and 2.23±0.92 respectively,and both were lower than 7.86±0.94 of pre-operation( P<0.01).Conclusion MED combined with RA is a effective treatment for multi-segmental lumbar disc herniation,it can relieve the nerve compression due to herniated disc immediately,reduce the p

关 键 词：后路椎间盘镜手术 射频消融术 腰椎间盘突出症 

分 类 号：R681.5[医药卫生—骨科学]