经皮全内镜下精准有限椎板间开窗术治疗腰椎间盘突出症的疗效分析  

Analysis of the therapeutic effect of percutaneous endoscopic precise limited intervertebral fenestration surgery for lumbar disc herniation

作　　者：李想[1] 贺海怿 李鹏[1] 张鹏飞[1] 郭强[1] LI Xiang;HE Hai-yi;LI Peng;ZHANG Peng-fei;GUO Qiang(Spinal Surgery of Sanmenxia Central Hospital,Henan Province,472000,China)

机构地区：[1]河南省三门峡市中心医院脊柱外科,河南三门峡472000

出　　处：《颈腰痛杂志》2023年第4期601-603,共3页The Journal of Cervicodynia and Lumbodynia

摘　　要：目的探讨经皮全内镜下精准有限椎板间开窗术治疗腰椎间盘突出症的临床疗效。方法回顾性分析2019年11月~2020年11月收治的27例LDH临床资料,均利用可视化环锯进行精准有限椎板间开窗、经椎板间隙入路脊柱内镜手术(Percutaneous endoscopic interlaminar discetomy,PEID),其中L_(4-5)节段8例,L_(5)-S_(1)节段19例。结果27例患者均顺利完成PEID手术,手术时间39~61 min,平均(48.2±7.5)min;术后住院时间2~4 d,平均(2.9±1.5)d;3例术后出现神经根水肿反应,对症治疗后好转;所有患者均未出现脑脊液漏或神经损伤、感染等并发症。与术前相比,所有患者术后1 d、3个月和1年的腰痛和下肢痛VAS评分、ODI指数均呈持续下降趋势(P<0.05)。术后1年按改良MacNab标准评价疗效,优16例,良9例,可2例,优良率为92.6%。结论精准有限椎板间开窗PEID手术治疗LDH,有效地扩大了脊柱内镜在后路椎管内的操作空间,可取得满意的减压效果,手术安全性高,有临床应用价值。Objective To explore the clinical efficacy of percutaneous total endoscopic precise limited intervertebral fenestration surgery for the treatment of lumbar disc herniation.Method A retrospective analysis was conducted on the clinical data of 27 cases of LDH admitted from November 2019 to November 2020,all of whom underwent precise limited interlaminar fenestration and percutaneous endoscopic discectomy(PEID)using a visual circular saw.Among them,8 cases were at the L_(_(4-5)) segment and 19 cases were at the L_(5)-S_(1) segment.Result All 27 patients successfully completed PEID surgery,with a surgical time of 39-61 minutes,with an average of(48.2±7.5)minutes;The postoperative hospitalization time was 2-4 days,with an average of(2.9±1.5)days;Three cases experienced postoperative nerve root edema reaction,which improved after symptomatic treatment;All patients did not experience complications such as cerebrospinal fluid leakage,nerve injury,or infection.Compared with preoperative,all patients showed a continuous downward trend in VAS scores and ODI index for low back and lower limb pain at 1 day,3 months,and 1 year after surgery(P<0.05).One year after surgery,the efficacy was evaluated according to the modified MacNab standard,with 16 cases being excellent,9 cases being good,and 2 cases being fair.The excellent and good rate was 92.6%.Conclusion Precise limited intervertebral fenestration PEID surgery for the treatment of LDH effectively expands the operating space of spinal endoscopy in the posterior spinal canal,achieves satisfactory decompression effect,has high surgical safety,and has clinical application value.

关 键 词：腰椎间盘突出症 脊柱内镜 椎板间入路 可视化环锯 减压 

分 类 号：R681.53[医药卫生—骨科学]