多通道经皮脊柱内镜手术治疗老年多节段腰椎间盘突出症  

Multi-channel percutaneous endoscopic spinal surgery for multi-segment lumbar disc herniation in the elderly

作　　者：王路[1] 程才[1] 李凌霞 李维彬[1] 辛大森 郭志远 韩红敏[1] WANG Lu*;CHENG Cai;LI Lingxia;LI Weibin;XIN Dasen;GUO Zhiyuan;HAN Hongmin(Department of Orthopaedics,Cangzhou Central Hospital,Cangzhou,Hebei 061000,China;不详)

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

出　　处：《中国骨与关节损伤杂志》2023年第3期239-242,共4页Chinese Journal of Bone and Joint Injury

摘　　要：目的 观察多通道经皮脊柱内镜手术治疗老年多节段腰椎间盘突出症的临床疗效。方法 回顾性分析自2018-08—2020-08采用多通道经皮脊柱内镜手术治疗的55例老年多节段腰椎间盘突出症,术前进行选择性神经根阻滞确定责任节段并做好标记,术中经工作通道置入脊柱内镜,用髓核钳清理局部软组织,双极射频局部止血、清理,显露椎间孔区域轮廓,用缆钳在靠近关节突处逐层切开部分黄韧带,显露盘黄间隙,置入髓核钳及缆钳进行椎间盘内减压并去除部分髓核。结果 本组手术时间为65~175 min,平均87.1 min。1例术中发生硬膜撕裂类脊髓高压反应,经去除水压、改变体位、吸氧等处理后症状于40 min后消失。1例术后出现患侧下肢股神经麻痹症状,营养神经、针灸治疗、功能锻炼4周后症状消失。55例均获得随访,随访时间12~18个月,平均13.8个月。所有患者均未发生永久性神经损伤、椎间隙感染。术后1、3、6、12个月疼痛VAS评分、ODI指数均较术前明显改善,差异有统计学意义(P<0.05)。末次随访时采用腰椎功能MacNab标准评定疗效:优31例,良15例,可9例。结论 多通道经皮脊柱内镜手术治疗老年多节段腰椎间盘突出症是安全、有效的,可以方便快捷地解除神经腹侧及背侧压迫软硬组织,可以有效分离粘连组织并进行神经根减压。Objective To observe the efficacy of multi-channel percutaneous spinal endoscopy in the treatment of multi-seg-ment lumbar disc herniation in the elderly.Methods A retrospective review was performed on 55 elderly patients with multi-ple segmental lumbar disc herniation treated by multichannel percutaneous spinal endoscopy from August 2018 to August 2020.The selective nerve block method was applied preoperatively to identify the responsible segment,the surgical interverte-bral space was located and a mark was made,the endoscopic working channel was established,forceps were used to clean up local soft tissue under spinal endoscopy,the bipolar radiofrequency hemostasis was performed,the soft tissue was cleaned,and the intervertebral foramen area was exposed.The yellow ligament was incised layer by layer near the articular process,the disc yellow space was revealed,and intradiscal decompression and partial nucleus pulposus removal were performed.Results The operative time ranged from 65 to 175 min,with a mean of 87.1 min.One patient developed a dural tear intraoperatively result-ing in a spinal cord like hypertensive response,and her symptoms disappeared within 40 min by removing water pressure,changing body position,and using oxygen inhalation.One patient developed symptoms of lower extremity femoral nerve palsy postoperatively,which resolved afer 4 weeks of treatment with neurotrophic,acupuncture physiotherapy,and functional exer-cise,and all patients had no serious complications such as permanent nerve injury and intervertebral space infection.Follow up was available for all 55 cases and ranged from 12 to 18 months(mean 13.8 months),the pain VAS score and ODI index at different time points(1,3,6,12 months)after surgery were significantly improved compared with those before surgery,with sig-nificant differences(P<0.05).At last follow-up according to the Macnab criteria for lumbar function,31 cases were excellent,15 cases good,and 9 cases fair.Conclusion Multichannel percutaneous spinal endoscopic treatment for elde

关 键 词：多节段腰椎间盘突出症 经皮脊柱内镜 微创 多通道 

分 类 号：R681.5[医药卫生—骨科学]