脊柱内镜下磨钻扩大腹侧空间治疗重度游离型腰椎间盘突出的可行性  

Feasibility of enlarging the ventral space by using a drill under spinal endoscopy in the treatment of severe free lumbar disc herniation

作　　者：何升华[1] 蓝志明[1] 任之强[1] 赖居易 冯华龙 HE Sheng-hua;LAN Zhi-ming;REN Zhi-qiang;LAI Ju-yi;FENG Hua-long(Shenzhen Hospital of Traditional Chinese Medicine,Shenzhen 518034,Guangdong,China)

机构地区：[1]深圳市中医院,广东深圳518034

出　　处：《中国骨伤》2023年第1期25-28,共4页China Journal of Orthopaedics and Traumatology

摘　　要：目的:应用脊柱内镜技术治疗重度游离型腰椎间盘突出症,探讨使用镜下磨钻扩大腹侧空间的可行性和应用价值,评估临床疗效。方法:收集2019年4月至2021年3月应用脊柱内镜技术治疗的重度游离型腰椎间盘突出患者30例,男19例,女11例;年龄19~76(44.03±16.92)岁;患者均为单一节段病变且髓核脱出,其中L2,33例,L3,43例,L4,515例,L5S19例。术中用镜下磨钻磨除椎体部分后缘骨质及椎弓根切迹,增大腹侧操作空间,显露游离的髓核并完整摘除。记录术中出血量、手术时间、住院时间及术后神经并发症,比较术前、术后2 d、3个月及1年的日本骨科协会(Japanese Orthopaedic Association,JOA)评分,Oswestry功能障碍指数(Oswestry disability index,ODI),疼痛视觉模拟评分(visual analogue scale,VAS),并根据腰椎功能Macnab标准评定疗效。结果:所有患者顺利完成手术,游离髓核取出完整,术后当天腰腿痛明显缓解,2例患者术后出现下肢一过性疼痛麻木,无严重神经损伤并发症发生。术后各时间点的ODI及VAS均较术前显著降低(P<0.01);JOA评分较术前明显升高(P<0.01)。术后第2天、3个月、1年时根据Macnab标准评定疗效,优良率分别为66.67%(20/30)、83.33%(25/30)和90.00%(27/30)。结论:重度游离型腰椎间盘突出,使用镜下磨钻扩大腹侧空间,能够顺利取出游离髓核,避免了神经损伤发生。Objective To evaluate the clinical efficacy of spinal endoscopy in the treatment of severe free lumbar disc herniation and explore the feasibility and application of microscopic drills to expand ventral space.Methods Thirty patients with severe free lumbar intervertebral disc herniation treated by spinal endoscopic technique from April 2019 to March 2021 were collected,including 19 males and 11 females;aged from 19 to 76 years with an average of(44.03±16.92)years old.All patients had a single segmental lesion with prolapse of the nucleus pulposus.Among them,there were 3 cases on L2,3,3 cases on L3,4,15 cases on L4,5,and 9 cases on L5S1.During operation,posterior bone of vertebral body and pedicle notch were removed by a drill under the endoscope to enlarge the ventral space.And the free nucleus pulposus was exposed and completely removed.The intraoperative blood loss,operation time,hospital stay and postoperative neurological complications were recorded,and Japanese Orthopaedic Association(JOA)score,Oswestry Disability Index(ODI)and visual analogue scale(VAS)were compared before operation,2 days,3 months and 1 year after operation,and Macnab standard was used to evaluate clinical efficacy.Results All operations were successful and the free nucleus pulposus was completely removed.Pain in the lower back and legs was significantly relieved on the day after operation.Two patients experienced transient pain and numbness in lower limbs after operation,and no serious nerve injury complications occurred.ODI and VAS at each time point after surgery were significantly lower than those before surgery(P<0.01),and JOA score was significantly higher than before surgery(P<0.01).The excellent and good rates of Macnab were 66.67%(20/30),83.33%(25/30)and 90.00%(27/30)on 2 days,3 months and 1 year after operation,respectively.Conclusion For severe free lumbar intervertebral disc herniation,using of a drill under endoscope to expand the ventral space can smoothly remove the free nucleus pulposus and avoid nerve damage.

关 键 词：腰椎 椎间盘移位 椎间盘摘除术 外科手术 内窥镜 

分 类 号：R681.5[医药卫生—骨科学]