经皮椎间孔镜治疗椎体后缘离断症的手术技巧及短期疗效观察  

Surgical techniques and short-term efficacy of percutaneous endoscopic lumbar discectomy in treatment of posterior apophyseal ring separation

作　　者：李成勇 石志 龚志强[3] 娄振凯[3] 赵石好 苗辉 王兵[3] LI Cheng-yong;SHI Zhi;GONG Zhi-Qiang;LOU Zhen-kai;ZHAO Shi-hao;MIAO Hui;WANG Bing(Spinal Surgery,the Affiliated Hospital of Yunnan University,Yunnan University,Kunming,Yunnan 650021,China;Department of Orthopedics,the First Hospital of Nanchang,Nanchang,Jiangxi 330008,China;Department of Orthopedics,the First Affiliated Hospital of Kunming Medical University,Kunming,Yunnan 650032,China)

机构地区：[1]云南大学附属医院脊柱外科,云南昆明650021 [2]南昌市第一医院骨科,江西南昌330008 [3]昆明医科大学第一附属医院骨科,云南昆明650032

出　　处：《颈腰痛杂志》2024年第2期248-251,共4页The Journal of Cervicodynia and Lumbodynia

基　　金：云南省科技厅重大科技专项计划(编号:202102AA310068);云南省教育厅科学研究基金项目(编号:2023Y0625);云南省骨关节疾病临床医学中心项目(编号:ZX2019-03-04)。

摘　　要：目的探讨经皮椎间孔镜手术(percutaneous endoscopic lumbar discectomy,PELD)治疗腰椎椎体后缘离断症(posterior apophyseal ring separation,PARS)的手术技巧及短期疗效。方法纳入PELD治疗的腰椎PARS患者53例,均采用症状较重侧椎间孔入路,通过恰当的手术技巧摘除突出椎间盘、摘除全部或部分离断骨块。于术前和术后3个月、1年、2年时,通过视觉模拟评分(visual analogue scale,VAS)评价患者腰、腿痛改善情况,Oswestry残疾指数(oswestry disability index,ODI)评估腰椎功能改善程度,采用改良MacNab标准评估疗效。结果所有手术顺利,无神经损伤、硬膜撕破及感染等并发症。复查CT显示减压良好,离断骨块全部切除32例,部分切除21例。所有患者均获得2年随访,与术前相比,术后腰、腿痛VAS和腰椎ODI均明显降低,差异有统计学意义(P<0.001);疗效评估优良率为94.34%。结论PELD治疗腰椎PARS具有创伤小、康复快、疗效好等优点,可作为手术治疗PARS的良好选择。Objective To investigate the surgical techniques and short-term effects of percutaneous endoscopic lumbar discectomy(PELD)for the treatment of posterior apophyseal ring separation(PARS).Methods Fifty-three patients with PARS treated with PELD were enrolled.All of them were treated with the more severe symptom-side intervertebral foramina approach,and the herniated intervertebral disc was removed by appropriate surgical techniques,and all or part of the separated bone were removed.The visual analogue scale(VAS)was used to evaluate the improvement of low back and leg pain before the operation and 3 months,1 year,and 2 years after the operation.The Oswestry disability index(ODI)was used to evaluate the improvement of lumbar spine function.The modified MacNab criteria was used to evaluate the efficacy.Results All operations went smoothly without complications such as nerve injury,dural tear and infection.Re-examination of CT showed that the decompression was good,32 cases of separated bone were completely excised,and 21 cases were partially excised.The patients were followed up for two years,VAS of low back and leg pain and ODI of lumbar function were all relieved significantly after operation.Compared with preoperatively,the difference was statistically significant(P<0.001),and the excellent and good rate was 94.34%.Conclusion PELD treatment of PARS has the advantages of less trauma,quick recovery,and good efficacy.It can be a good choice for surgical treatment of PARS.

关 键 词：腰椎椎体后缘离断症 经皮椎间孔镜 微创 

分 类 号：R687.3[医药卫生—骨科学]