腰椎间盘突出症两种脊柱内镜术早期并发症分析  

Early complications of two spinal endoscopies for lumbar disc herniation

作　　者：赵红卫[1] 刘丰平[1] 皮闻森 罗茗刈[1] 卢斌[1] ZHAO Hong-wei;LIU Feng-ping;PI Wen-sen;LUO Ming-yi;LU Bin(Department of Spinal Surgery,The First Clinical College,Three Gorges University,Yichang 443000,China)

机构地区：[1]三峡大学第一临床医学院脊柱外科,湖北宜昌443000

出　　处：《中国矫形外科杂志》2021年第19期1729-1733,共5页Orthopedic Journal of China

基　　金：2020年宜昌市医疗卫生研究项目资助项目(编号:A20-2-007)。

摘　　要：[目的]比较两种脊柱内镜治疗腰椎间盘突出症围手术期并发症,总结原因并探讨防治策略。[方法]2018年1月-2020年1月,本科采用微创手术治疗椎间盘突出症患者340例。其中,130例采用椎间盘镜术(micro endoscopic discectomy,MED),210例采用椎间孔镜术(percutaneous transforaminal endoscopic discectomy,PTED)。记录并比较两组术中及术后1个月内发生的与手术直接相关的并发症与不良事件。采用单因素分析与逻辑回归分析探讨PTED术后主要并发症的危险因素。[结果]340例中,共发生并发症48例,总发生率为14.12%(48/340)。并发症发生的频度依次为:下肢感觉异常或加重(7.65%)>硬脊膜损伤(2.94%)>硬膜外血肿形成(0.88%)>手术节段错误(0.29%)、器械断裂(0.29%)、类脊髓高压综合征(0.29%)以及休克(0.29%)。MED组硬脊膜损伤发生率(5.38%)显著高于PTED组(1.43%)(P<0.05);而MED下肢感觉异常或加重发生率(3.08%)显著低于PTED组(10.48%)(P<0.05)。逻辑回归表明:高龄(OR=1.877,P<0.05)、术前感觉异常程度重(OR=2.879,P<0.05)、低位(L_(s)S_(1))突出节段(OR=4.598,P<0.05)、突出位置为极外侧型(OR=2.110,P<0.05)以及病变类型为脱出型(OR=1.667,P<0.05)是PTED术后发生下肢感觉异常的危险因素。[结论]对于MED术应着重关注硬脊膜损伤,而PTED术应关注术后下肢感觉异常。患者年龄大、术前感觉异常程度重、L_(5)S_(1)突出节段、极外侧型突出、脱出型病变为PTED术下肢感觉异常加重的危险因素。[Objective]To compare the perioperative complications of two spinal endoscopies for lumbar intervertebral herniation,summarize the reasons and discuss the prevention and treatment strategies.[Methods]From January 2018 to January 2020,a total of 340 patients underwent minimally invasive surgeries for intervertebral disc herniation in our department.Among them,130 patients received micro endoscopic discectomy(MED),while the remaining 210 patients underwent percutaneous transforaminal endoscopic discectomy(PT-ED).The complications and adverse events directly related to the operation that occurred during the operation and within 1 month after the operation were recorded and compared between the two groups.Univariate analysis and multivariate logistic regression were used to explore the risk factors of major complications after PTED.[Results]Among the 340 patients,48 patients had complications occurred,accounted for 14.12%(48/340).The frequency of complications ranked up-down in order of:lower limb paresthesia or pain aggravation(7.65%)>dural injury(2.94%)>epidural hematoma formation(0.88%)>surgical positioning error(0.29%),instrument breakage(0.29%),spinal hypertension syndrome(0.29%)and shock(0.29%).The MED had significantly higher incidence of dural injury(5.38%vs 1.43%,P<0.05),whereas significantly lower incidence of lower limb paresthesia or pain aggravation(3.08%vs 10.48%,P<0.05)than the PTED.As results of logistic regression,the advanced age(OR=1.877,P〈O.O5),severity of preoperative paresthesia(OR=2.879,P<0.05),low-level disc pro-trusion(L_(5)S_(1))(OR=4.598,P<0.05),extremely lateral protrusion(OR=2.110,P<0.05),and prolapsed lesion(OR=1.667,P<0.05)were risk factors for postoperative lower limb paresthesia or pain aggravation after PTED.[Conclusion]Attention should be paid to spinal dural inju-ry for MED,while to postoperative lower extremity paresthesia or pain aggravation for PTED.The advanced age,severe preoperative paresthesia,L5S1 herniation,extremely lateral protrusion,and prolapsed lesions are risk fact

关 键 词：腰椎间盘突出症 椎间盘镜术 椎间孔镜术 围手术期并发症 

分 类 号：R681.53[医药卫生—骨科学]