经皮椎间孔镜治疗重度脱垂移位型腰椎间盘突出症  

Percutaneous endoscopic lumbar discectomy for extremely migrated lumbar intervertebral disc herniation

作　　者：陈松 张为[2] 索世琪[1] 李成立 董晓辉[1] 付治安[1] CHEN Song;ZHANG Wei;SUO Shi-qi;LI Cheng-li;DONG Xiao-hui;FU Zhi-an(Department of Spine Surgery,The Af-filiated Hospital,Hebei University of Engineering,Handan 056002,China;Department of Spinal Surgery,The Third Hospital,Hebei Medical University,Shijiazhuang 050051,China)

机构地区：[1]河北工程大学附属医院脊柱外科,河北邯郸056002 [2]河北医科大学第三医院脊柱外科,石家庄市050051

出　　处：《中国矫形外科杂志》2020年第19期1748-1752,共5页Orthopedic Journal of China

摘　　要：[目的]评估经皮椎间孔镜下腰椎间盘切除术治疗重度脱垂移位型腰椎间盘突出症的临床疗效。[方法]回顾性分析2016年4月~2018年1月经皮椎间孔镜手术治疗的36例重度脱垂移位型椎间盘突出症患者,总结患者围手术期、随访与影像资料。[结果]36例患者均顺利完成手术,无严重术中和围手术期并发症。随访18个月以上,随时间推移,36例患者的VAS和ODI评分显著减少,而JOA评分显著增加(P<0.05)。改良MacNab标准评价临床结果优良率随时间推移显著增加(P<0.05)。影像方面,术后影像显示关节突腹侧和椎体后上缘部分骨质被磨除,相应的椎体无骨折,未见椎间不稳。术后3个月及末次随访时腰椎MRI复查与术前相比,显示椎管减压彻底,手术节段无复发。[结论]经皮椎间孔镜技术可有效治疗重度脱垂移位型椎间盘突出症,具有创伤小、住院时间短、术后恢复快等优点。[Objective]To assess the clinical outcomes of transforaminal percutaneous endoscopic lumbar discectomy(PELD)through superior vertebral pedicle notch for high-grade inferiorly migrated lumbar intervertebral disc herniation.[Methods]A retrospective study was conducted on 36 patients who underwent PELD for high-grade inferiorly migrated lumbar intervertebral disc herniation through the superior vertebral pedicle notch from April 2016 to January 2018.The perioperative,follow-up and radiographic documents were summarized.[Results]All patients had PELD performed smoothly without serious complications in operation and perioperative period.The VAS and ODI scores significantly decreased,whereas the JOA score significantly increased in the 36 patients as time went(P<0.05).Based on MacNab’s criteria,the excellent and good rate of clinical consequences significantly upgraded over time(P<0.05).In term of radiographic assessments,the postoperative images revealed that partial bone on the posterior vertebral body was removed without any sign of corresponding vertebral fracture or intervertebral instability.However,the complete spinal canal decompression was showed by MRI at 3 months postoperatively and the latest follow-up in all the patients,whereas no recurrent intervertebral disc herniation was noticed in anyone of them.[Conclusion]This percutaneous endoscopic lumbar discectomy through superior vertebral pedicle notch does effectively treat the high-grade inferiorly migrated lumbar intervertebral disc herniation with advantages of minimizing iatrogenic trauma,shortening hospital stay and improving postoperative recovery.

关 键 词：腰椎间盘突出症 重度脱垂移位 经皮内镜腰椎间盘切除术 上椎弓根切迹 

分 类 号：R681.53[医药卫生—骨科学]