经皮脊柱内镜下椎间盘切除术治疗腰椎间盘突出症1年疗效随访研究  

AN ONE-YEAR FOLLOW-UP STUDY ON LUMBAR DISC HERNIATION IN PATIENTS AFTER TRANSFORAMINAL PERCUTANEOUS ENDOSCOPIC LUMBAR DISCECTOMY

作　　者：王睿娴 田心毅 占恭豪[1] 李军[2] 许峰[1] 吴彬彬[1] WANG Rui-Xian;TIAN Xin-Yi;ZHAN Gong-Hao;LI Jun;XU Feng;WU Bin-Bin(Department of pain treatment,the Second Affiliated Hospital of Wenzhou Medical University,Wenzhou,325027,China;Department of Pain Anesthesiology,the Second Affiliated Hospital of Wenzhou Medical University,Wenzhou,325027,China)

机构地区：[1]温州医科大学附属第二医院育英儿童医院疼痛科,温州325027 [2]温州医科大学附属第二医院育英儿童医院麻醉科,温州325027

出　　处：《中国疼痛医学杂志》2019年第8期603-607,共5页Chinese Journal of Pain Medicine

基　　金：温州市科技局课题（Y20160392）;浙江省医学会课题(2015ZYC-A28)

摘　　要：目的:探讨经皮腰脊柱内镜技术(percutaneous endoscopic lumbar discectomy,PELD)对腰椎间盘突出症(lumbar disc herniation,LDH)的长期临床疗效。方法:纳入120名在2015年7月至2016年4月期间于温州医科大学附属第二医院疼痛科接受PELD手术治疗的腰椎间盘突出症确诊病人120例。通过电话随访方式对他们术后跟踪1年,主要记录病人术前、术后1d、7d、30d、90d、180d和术后1年病人腰部疼痛情况,采用数字评分法(numeric rating scale,NRS)和Oswestry功能障碍指数(oswestry disability index,ODI)评分。在最后一次随访时采用改良Macnab标准对病人进行评估、并记录并发症和腰椎间盘突出症复发例数。结果:共纳入120名腰椎间盘突出症确诊病人,有女性病人47例、男性病人73例。有14例病人在术后30天至术后180天期间失访,因此共有106名病人完成1年随访。病人术后各时点NRS评分和ODI值均较术前显著降低(P<0.05)。术后1年Macnab评估结果为69例"优"、31例"良"、4例"可"、2例"差",其中有1例病人术中发生神经根损伤、2例发生硬膜囊撕裂。有2例病人在此次住院期间接受第二次PELD手术治疗。腰椎间盘突出症复发例数为2。结论:PELD可有效降低LDH病人术后疼痛和改善病人生活质量,为治疗LDH的有效微创手术方式。Objective:Percutaneous endoscopic lumbar discectomy (PELD) is an common therapy for lumbar disc herniation (LDH) nowadays.Much advancement has been achieved in recent decades.The present study aimed to investigate the therapeutic effect of PELD with following up 120 LDH patients for one year after the surgery.Methods:In this study,120 patients diagnosed with LDH received PELD during July 2015 and April 2016 in the Second Affiliated Hospital of Wenzhou Medical Universtiy were included.We recorded the symptom duration,operation time,reoperation incidence,complication incidence and hospital stay.Moreover, we also assessed the clinical outcomes with the numeric rating scale (NRS) and the oswestry disability index (ODI) pre-operatively and post-operatively (postoperative 1 day,7 days,30 days,90 days,180 days and 1 year), respectively.The postoperative-one-year clinical efficacy of the included patients was evaluated with modified Macnab criteria at the final followup.Results:Forty seven women and seventy three men were included.Among these included patients,4 presented lower limbs numbness,17 presented low back pain,28 had leg pain,and other 71 patients had both low back pain and leg pain.Nerve root injury occurred in one patient and dural tear occurred in two patient,thus,the incidence was 0.83% and 1.66%,respectively.Two patients needed to receive the second PELD treatment during the hospital stay.So the re-operation incidence was 0.83% in this study. Both the postoperative NRS and ODI decreased significantly compared with pre-operation (P < 0.05).Totally, 14 patients were lost to follow up and 106 patients completed the one-year follow-up.Evaluated with modified Macnab criteria at the final visit,the results was excellent in 69 patients,good in 31 patients,fair in 4 patients and poor in 2 patients.2 patients was found recurrent LDH during one year.Conclusions:After treatment with PELD,the postoperative NRS score and ODI of the included LDH patients were both significantly decreased compared with pre-operation.Thus,

关 键 词：腰椎间盘突出症 经皮脊柱内镜 微创 疗效随访 

分 类 号：R687.3[医药卫生—骨科学]