脊柱内镜下经椎板锁孔技术治疗重度脱垂型腰椎间盘突出症的疗效分析  

Clinical efficacy of percutaneous endoscopic lumbar discectomy via a translaminar“Keyhole” approach for highly down-migrated lumbar disc herniation

作　　者：虞攀峰 张西峰[2] 黄鹏[2] 周建伟[1] 强华[1] YU Pan-feng;ZHANG Xi-feng;HUANG Peng;ZHOU Jian-wei;QIANG Hua(Department of Orthopedics,Beijing Tongren Hospital,Capital Medical University,Beijing 100730,China)

机构地区：[1]首都医科大学附属北京同仁医院骨科,北京100730 [2]解放军总医院第一医学中心骨科

出　　处：《中国骨与关节损伤杂志》2019年第5期464-467,共4页Chinese Journal of Bone and Joint Injury

摘　　要：目的探讨脊柱内镜下经椎板锁孔技术治疗重度脱垂型腰椎间盘突出症的可行性、有效性。方法回顾性分析自2015-01—2017-10采用脊柱内镜下经椎板锁孔技术治疗的12例重度脱垂型腰椎间盘突出症。比较术前及术后1 d、术后1个月腰痛VAS评分、下肢痛VAS评分及ODI指数。术后1年时采用改良MacNab评分标准评定疗效。结果本组手术时间为48～77 min,平均63 min;术中出血量为10～45 ml,平均24.2 ml。12例均获得随访,随访时间平均22.2(14～35)个月。术后3个月随访时复查腰椎MRI证实髓核均成功摘除,无残留髓核突出及复发患者。术后1年随访时采用改良MacNab评价标准评定疗效:优7例,良4例,可1例。术后1 d腰痛VAS评分、下肢痛VAS评分及ODI指数均较术前明显改善,而且术后1月以上指标较术后1 d明显改善,差异有统计学意义(P <0.05)。结论脊柱内镜下经椎板锁孔技术治疗重度脱垂型腰椎间盘突出症安全有效,创伤小、髓核摘除彻底、术后康复迅速、功能恢复满意。Objective To investigate the feasibility and efficacy of percutaneous endoscopic lumbar discectomy(PELD)via a translaminar"Keyhole"approach for the treatment of highly down-migrated lumbar disc herniation(HD-LDH).Methods From January 2015 to October 2017,12 patients with HD-LDH receiving PELD via a translaminar"Keyhole"approach were retrospectively analyzed.Visual analogue scale(VAS,lower back and leg)and Oswestry disability index(ODI)before operation were compared with those 1 day and 1 month after operation.Modified MacNab criterion evaluated at 1 year postoperatively was used to identify the clinical efficacy.Results The operation time was 48 to 77 minutes,with an average of 63 min;blood loss was 10 to 45 ml,with an average of 24.2 ml.All the 12 patients were followed up with an average period of 22.2(14-35)months.Lumbar MRI examined at 3 months postoperatively showed the highly down-migrated lumbar disc of the 12 patients were successfully removed without residue or re-recurrence.Modified MacNab criterion evaluated at 1 year postoperatively indicated an efficacy of 7 excellent cases,4 good and 1 fair.VAS score of the lower back and leg and ODI score at 1 day postoperatively were significantly improved compared with preoperative ones;and values of the follow-up time points were significantly improved compared with ones 1 day after operation(P<0.05).Conclusion PELD via a translaminar"Keyhole"approach is a safe and efficient technique for the treatment of HD-LDH.The advantages are as follows:less trauma and complete disc removal,fast rehabilitation and satisfactory functional recovery.

关 键 词：重度脱垂型腰椎间盘突出症 脊柱内镜 椎间盘切除 经椎板锁孔技术 

分 类 号：R681.5[医药卫生—骨科学]