经皮脊柱内镜“隔离区”技术治疗椎间盘源性腰痛的临床疗效观察  

Observation on the clinical efficacy of percutaneous spinal endoscopy“isolation zone”technique in treatment of discogenic low back pain

作　　者：王路[1] 李凌霞 程才[1] 辛大森 郭志远 李维彬[1] 侯汉辉 韩红敏[1] WANG Lu;LI Ling-xia;CHENG Cai(First Department of Orthopaedics,Cangzhou Central Hospital,Hebei 061001,China)

机构地区：[1]沧州市中心医院骨一科,河北061001 [2]沧州市人民医院临床药学室,河北061000

出　　处：《中国临床新医学》2022年第11期1034-1038,共5页CHINESE JOURNAL OF NEW CLINICAL MEDICINE

基　　金：河北省医学科学课题计划项目(编号:20210205)。

摘　　要：目的观察经皮脊柱内镜“隔离区”技术治疗椎间盘源性腰痛的临床疗效。方法选择2017年9月至2020年9月沧州市中心医院收治的椎间盘源性腰痛患者45例。采用局麻下侧方入路经皮脊柱内镜手术治疗,行内镜下髓核摘除、纤维环成形、黄韧带去神经化及相应节段走行神经根全程减压,形成神经根周围与髓核及纤维环无接触的“隔离区”。记录术前及术后1、3、6、12个月的视觉模拟量表(VAS)评分和Oswestry功能障碍指数(ODI)评分,并于末次随访采用改良MacNab标准评价临床疗效。结果45例均顺利完成手术,手术时间65~125(94.7±17.7)min。1例术中出现类脊髓高压反应,予去除水压、吸氧等处理后30 min症状消失。l例术后出现股神经麻痹症状,予以神经营养、针灸理疗、功能锻炼保守治疗,术后4周症状消失。患者均无永久性神经损伤、椎间隙感染等严重并发症。术后腰背部及腰骶部的疼痛VAS评分及ODI评分均较术前得到显著改善(P<0.05)。根据改良MacNab标准,末次随访时疗效为优者24例,良13例,可8例,优良率为82.2%。结论经皮脊柱内镜“隔离区”技术治疗椎间盘源性腰痛安全、有效,值得临床推广。Objective To observe the clinical efficacy of percutaneous spinal endoscopy“isolation zone”technique in treatment of discogenic low back pain.Methods Forty-five patients with discogenic low back pain admitted to Cangzhou Central Hospital from September 2017 to September 2020 were selected.The patients were treated with percutaneous spinal endoscopic surgery via lateral approach under local anesthesia.Endoscopic removal of nucleus pulposus,annulus fibrosis forming,denervation of ligamentum flavum and decompression of the corresponding segmental nerve roots throughout the process,forming an“isolation zone”around the nerve root without contact with the nucleus pulposus and annulus fibrosis were performed.Visual Analogue Scale(VAS)scores and Oswestry Disability Index(ODI)scores were recorded before surgery and 1,3,6,and 12 months after surgery,and the clinical efficacy were evaluated using modified MacNab criteria at the last follow-up.Results The operations on the 45 cases were successfully completed,and the operation time was 65-125(94.7±17.7)minutes.One case had a spinal cord hypertensive reaction during the operation,and the symptom disappeared 30 minutes after the removal of water pressure and oxygen inhalation.One case had symptoms of femoral nerve palsy after operation,and was treated conservatively with neurotrophy,acupuncture and moxibustion physiotherapy and functional exercise,and the symptoms disappeared 4 weeks after operation.There were no serious complications such as permanent nerve damage and intervertebral space infection in the patients.The VAS scores and ODI scores of the pain in the lower back and lumbosacral region after operation were significantly improved compared with those before operation(P<0.05).According to the modified MacNab criteria,at the last follow-up,the curative effect was excellent in 24 cases,good in 13 cases,and fair in 8 cases,with an excellent and good rate of 82.2%.Conclusion The percutaneous spinal endoscopy“isolation zone”technique is safe and effective in tr

关 键 词：椎间盘源性腰痛 隔离区 内镜 经椎间孔神经阻滞 

分 类 号：R681.5[医药卫生—骨科学]