经皮内镜下腰椎间盘切除术治疗老年腰椎退行性疾病的探讨  

Complications after percutaneous endoscopic lumbar discectomy in the treatment of senile lumbar degenerative diseases

作　　者：安立琨[1] 藏磊[1] 袁硕[1] 杨立辉[1] 柳伟[1] 朱文艺[1] AN Li-kun;ZANG Lei;YUAN Shuo;YANG Li-hui;LIU Wei;ZHU Wen-yi(Department of Orthopaedics,Chaoyang Hospital,Capital Medical University,Beijing,100043,China)

机构地区：[1]首都医科大学附属北京朝阳医院西院骨科

出　　处：《中国骨与关节杂志》2019年第11期842-849,共8页Chinese Journal of Bone and Joint

摘　　要：目的总结经皮内镜下腰椎间盘切除术(percutaneous endoscopic lumbar discectomy,PELD)治疗老年腰椎退行性疾病的手术相关并发症,并探讨其防治方法。方法2016年1月至2017年9月,我院采用PELD共治疗老年腰椎退行性疾病患者263例,其中男137例,女126例;年龄60~84岁,平均70.5岁;单纯腰椎间盘突出症78例,退变性腰椎滑脱症18例,腰椎管狭窄症96例,腰椎管狭窄合并腰椎间盘突出症71例。患者均有中到重度的下腰痛,伴(或不伴)下肢麻痛、间歇性跛行;均行腰椎正侧位及动力位X线片,腰椎间盘CT扫描以及腰椎MRI检查,术前通过一次或多次腰脊神经封闭术明确责任节段,所有患者诊断明确,至少保守治疗1个月无效。均在局麻及影像监视下行PELD。观察术中、术后并发症及其处理方法。结果随访3~24个月,平均13.5个月,共发生并发症及失败病例28例,发生率为10.64%。其中术后神经反应12例,3例行神经根封闭治疗后好转,9例行营养神经、消炎镇痛保守治疗后恢复。神经根损伤4例(包括1例合并硬脊膜损伤),均有肌力下降,经保守治疗3例恢复,1例合并硬脊膜损伤转为后路腰椎管减压椎间植骨融合术(posterior lumbar interbody fusion,PLIF),术后1年肌力未恢复。硬脊膜破裂2例(包括1例合并有神经根损伤),1例术后无不适症状,保守治疗;1例合并神经根损伤,术后MRI证实脑脊液漏,转为PLIF手术,行腰大池引流,术后随访1年肌力未恢复。神经根周围血肿1例,术后MRI证实,再次PELD清除血肿。颅内高压症1例,术中昏迷,立即停止手术,予甲泼尼龙、甘露醇治疗后苏醒。复发4例,2例二次PELD术后好转;1例再行PELD、后路显微内镜腰椎间盘切除术(microendoscopic discectomy,MED)两次手术后好转;1例术后出现感染及间盘复发,再次行PELD清创、置管冲洗后好转。术后假性囊肿1例,MRI明确诊断,保守治疗后恢复。失败病例4例,术后症状无缓解或加重,均�Objectives To summarize complications after percutaneous endoscopic lumbar discectomy(PELD)in the treatment of senile lumbar degenerative diseases,and to discuss the prevention and treatment.Methods A retrospective review was performed on 263 patients(137 males and 126 females)with senile lumbar degenerative diseases.All patients underwent PELD between January 2016 and September 2017.The average age was 70.5 years(range:60-84 years).There were 78 cases of lumbar disc herniation,96 cases of lumbar spinal stenosis,71 cases of lumbar spinal stenosis with lumbar disc herniation and 18 cases of degenerative spondylolisthesis.All patients were exposed to medium or severe low back pain,with(or without)leg pain and intermittent claudication.Lumbar lateral and dynamic X-ray,CT scanning and MRI examination were performed.One or more spinal nerve block was conducted to confirm the responsibility segment.Conservative treatment had been proved to be not effective for at least 1 month.PELD was performed under local anesthesia and image surveillance.Intraoperative,postoperative complications and corresponding treatment were observed.Results All patients were followed up for 3 to 24 months,with an average of 13.5 months.Complications were found in 28 cases with an incidence rate of 10.64%.There were 12 cases of postoperative nerve reaction,among whom 3 cases improved after nerve root sealing and 9 cases recovered after conservative treatment of nerve nutrition and anti-inflammatory analgesic;4 cases of nerve root injury(including 1 case with dural tear)had muscle strength decline,among whom 3 cases recovered after conservative treatment and 1 case combined with dural tear was converted to PLIF operation(posterior lumbar interbody fusion)without muscle strength recovery 1 year later;2 cases were of dural tear(including 1 case with nerve root injury),among whom 1 case with no symptoms underwent conservative treatment and 1 case was converted to PLIF operation due to postoperative MRI confirmed cerebrospinal fluid leakage,but no mu

关 键 词：腰椎 椎间盘退行性变 最小侵入性外科手术 手术后并发症 

分 类 号：R681.5[医药卫生—骨科学]