经皮椎间孔镜治疗单节段腰椎间盘突出症合并侧隐窝狭窄的临床疗效  

Clinical Effect of Percutaneous Transforaminal Endoscopic Lumbar Discectomy for Single-segment Lumbar Disc Herniation Combined with Lateral Recess Stenosis

作　　者：王想福[1] 杨焕莹 赵道洲[3] 张万乾 陈伟国 游翔宇 赵恒 郑刚 张超[2] 桑廷瑞 WANG Xiang-fu;YANG Huan-ying;ZHAO Dao-zhou;ZHANG Wan-qian;CHEN Wei-guo;YOU Xiang-yu;ZHAO Heng;ZHENG Gang;ZHANG Chao;SANG Ting-rui(Department of Minimally Invasive Spine Surgery, Gansu Provincial Hospital of TCM, Lanzhou 730050, Gansu, China;Gansu University of Chinese Medicine, Lanzhou 730030, Gansu, China;International Medical Service, Gansu Provincial Hospital of TCM, Lanzhou 730050, Gansu, China;Institute of Orthopedic Trauma, Gansu Provincial Hospital of TCM, Lanzhou 730050, Gansu, China;Trauma Center, Gansu Provincial Hospital of TCM, Lanzhou 730050, Gansu, China)

机构地区：[1]甘肃省中医院脊柱微创骨科,甘肃兰州730050 [2]甘肃中医药大学,甘肃兰州730030 [3]甘肃省中医院国际医疗部,甘肃兰州730050 [4]甘肃省中医院骨伤病研究所,甘肃兰州730050 [5]甘肃省中医院创伤中心,甘肃兰州730050

出　　处：《中国现代手术学杂志》2022年第1期38-44,共7页Chinese Journal of Modern Operative Surgery

基　　金：兰州市人才创新创业项目(2020-RC-54);国家自然科学基金(81760877);甘肃省科技计划项目(创新基地和人才计划)(21JR1RA058)。

摘　　要：目的探讨经皮椎间孔镜技术治疗单节段腰椎间盘突出症合并侧隐窝狭窄的临床疗效。方法选择我院2016年1月至2018年1月收治的126例腰椎间盘突出症合并侧隐窝狭窄患者,均行经皮椎间孔镜髓核摘除神经根减压术(percutaneous transforaminal endoscopic discectomy,PTED)。观察手术时间、腰腿痛VAS评分、ODI指数、末次随访MacNab评分以及并发症等。结果本组126例患者均顺利完成PTED术,术中均无明显出血,无一例转为开放手术。手术时间55~113 min,平均(66.09±10.98)min。术后随访36~60个月,平均(45.48±6.74)个月。术后3 d,1、3、6、12个月及末次随访患者腰腿痛VAS评分、ODI指数均较术前明显改善,差异均有统计学意义(P<0.05)。末次随访按MacNab评分评价疗效:优66例,良42例,可18例,优良率为85.71%。术后3个月复查MRI未见残留突出的髓核组织,无复发,侧隐窝位置明显增宽。术后并发症6例(4.76%),其中术后1 d内出现一过性神经刺激症状5例,术后伤口轻度血肿1例,无硬膜囊破裂、椎间隙感染及脑脊液漏等严重并发症。结论经皮椎间孔技术治疗单节段腰椎间盘突出症(L4/5)合并侧隐窝狭窄,具有安全、创伤小、减压充分、手术时间短、恢复快、并发症少等优势,临床疗效确切。Objective To investigate the clinical effect of percutaneous transforaminal technique in the treatment of single-segment lumbar disc herniation(LDH)combined with lateral recess stenosis(LRS).Methods A total of 126 cases with single-segment LDH of L4/5 combined with LRS from January 2016 and January 2018 were enrolled and analyzed retrospectively.The surgery of percutaneous transforaminal endoscopic discectomy(PTED)and nerve root decompression was performed in all cases.The operation time,VAS score of low back and leg pain,ODI index,MacNab score of the last follow-up and complications were observed.Results The surgery was accomplished successfully in all 126 patients without obvious bleeding or converting to open surgery.The operation time was 55 to 113 min with average of(66.09±10.98)min.All cases were followed up for 36 to 60 months with average of(45.48±6.74)months.The VAS score of and ODI index was improved at 3 d,1,3,6,12 months and the last follow-up after the surgery than those before the surgery,and the difference was significantly(P<0.05).The curative effect was revealed that excellence in 66 cases,good in 42 cases,fair 18 cases with the fineness rate of 85.71%according to MacNab score at the last follow-up.MRI showed no prominent residual nucleus pulposus tissue,no recurrence and the lateral recess widened 3 months after operation.Postoperative complications were found in 6 cases,including 5 of transient nerve irritation within one day after the operation and 1 of mild hematoma.There was no serious complication occurred such as dural sac rupture,intervertebral space infection and cerebrospinal fluid leakage.Conclusion PTED is a safe and mini-trauma treatment for single-segment LDH(L4/5)complicated with LRS,and it can achieve precise effect with the advantage of sufficient decompression,short operation time,rapid recovery and less complications.

关 键 词：经皮椎间孔镜髓核摘除术 腰椎间盘突出症 侧隐窝狭窄 椎间孔入路 

分 类 号：R681.53[医药卫生—骨科学]