不同手术节段经皮椎间孔镜下腰椎间盘切除术的临床效果  

Clinical Effect after Percutaneous Endoscopic Lumbar Discectomy according to the Different Operation Level

作　　者：何玉宝[1] 徐执扬[1] 王洁颖[1] 刘波[2] HE Yu-bao;XU Zhi-yang;WANG Jie-ying;LIU Bo(Department of Orthopedics,Beijing Chuiyangliu Hospital,Beijing 100022,China;Department of Spinal Surgery,Beijing Jishuitan Hospital,Beijing 100035,China)

机构地区：[1]北京市垂杨柳医院骨科,北京100022 [2]北京积水潭医院脊柱外科,北京100035

出　　处：《科学技术与工程》2020年第36期14869-14874,共6页Science Technology and Engineering

摘　　要：为评价不同手术节段腰椎间盘突出症,经皮椎间孔镜下腰椎间盘切除术(percutaneous endoscopic lumbar discectomy,PELD)的临床效果,通过回顾性分析2014年1月—2017年6月清华大学附属垂杨柳医院骨科收治行PELD的腰椎间盘突出症患者临床资料的方法,研究不同手术节段腰椎间盘突出症PELD的临床效果。根据不同手术节段,分为3组:A组为L2-3和L3-4,B组为L4-5,C组为L5-S1。所有患者行单节段PELD手术。术前、术后3 d、3个月和6个月通过Oswestry腰椎功能障碍指数(Oswestry disability index,ODI)评分和改良MacNab标准评价临床效果。结果表明:A组患者的平均年龄、身体质量指数(body mass index,BMI)最小,病程、住院时间和随访时间最短,Pfirrmann分级Ⅲ级占68.8%;而C组Ⅳ级占48.0%,但是,三组患者没有显著统计学差异。A组均为椎间孔入路,B组绝大部分为椎间孔入路(90.3%);而C组以椎板间入路为主(68.0%)。与其他两组相比,C组手术时间长(P<0.05),出血量多(Ρ<0.05)。A组没有发生手术相关并发症,也没有术后复发病例,而C组手术相关并发症发生率(12.0%)最高,复发概率(4.0%)也最高,B组居于两者之间(6.4%和3.2%);但是并没有统计学差异。尽管C组患者术后ODI评分得到很大改善,但是不如其他两组明显(Ρ<0.05),尤其是术后3个月ODI评分高于其他两组(Ρ分别为0.039和0.028)。术后6个月C组ODI评分仍然高于其他两组,但是没有统计学差异(Ρ>0.05)。术后6个月随访时,根据改良MacNab评价标准,总体优良率为95.9%,三组比较没有明显差异(Ρ>0.05)。可见不同椎间隙水平的腰椎间盘突出症患者PELD术后临床效果不同,L5-S1手术时间相对长,出血量相对多,并发症发生率相对高,且术后ODI评分改善不如其他两组明显,需严格掌握适应证,周密术前计划。The research aimed to evaluate the impact of the operation level on clinical effect of various percutaneous endoscopic lumbar discectomies(PELD).Clinical data of patients diagnosed with lumbar disc hernia operated PELD in Beijing Chuiyangliu Hospital from January 2014 to June 2017 was used to investigate the impact of the operation level on clinical effect.According to the operation level,three groups were divided:as Group A for L2-3 and L3-4,Group B for L4-5,and Group C for L5-S1.All patients underwent single level PELD.Their clinical effect was evaluated by the Oswestry disability index(ODI)and modified MacNab criteria in four periods as before the operation,3 days,3 months,and 6 months postsurgery.The results show that group A is the youngest,its body mass index(BMI)is the smallest,and the duration of disease,hospitalization time and follow-up time are the shortest.Pfirrmann gradeⅢlevel accounts for 68.8%in group A,whileⅣlevel accounts for 48%in group C.However,no significant differences are found among three groups.All of group A are intervertebral foramen approach,and most of group B are intervertebral foramen approach(90.3%),while the interlaminar approach is the main approach in group C(68%).Compared with the other two groups,the operation time of group C is longer(Ρ<0.05),and the amount of bleeding is more(Ρ<0.05).No operation related complications and no postoperative recurrence are found in group A.The incidence of operation related complications in group C is the highest(12%)and the recurrence rate is the highest(4%).That Group B is between them(6.4%and 3.2%),but there is no statistically significant difference.Although the ODI scores in group C are greatly improved after operation,but not as well as in the other two groups(Ρ<0.05),especially in 3 months after operation(Ρis 0.039 and 0.028,respectively).6 months after the operation,the ODI score in group C is still higher than the other two groups,but there is no statistical difference(Ρ>0.05).After 6 months of follow-up,the overall good rate

关 键 词：经皮椎间孔镜下腰椎间盘切除术 腰椎间盘突出症 手术节段 临床效果 

分 类 号：R683.2[医药卫生—骨科学]