单孔分体内镜下腰椎间盘髓核切除术治疗单节段腰椎间盘突出症33例  

Single-Segment Lumbar Disc Herniation Treated with One-Hole Split Endoscope Technique:33 Cases Report

作　　者：付豪 赵刚 尚利杰 常青 林旭鑫 栗林 王怡帆 周鹭凡 FU Hao;ZHAO Gang;SHANG Lijie;CHANG Qing;LIN Xuxin;LI Lin;WANG Yifan;ZHOU Lufan(Graduate School of Henan University of Chinese Medicine,Zhengzhou 450046,China;Luoyang Orthopaedic-Traumatological Hospital of Henan Province(Henan Provincial Orthopaedic Hospital),Luoyang 471002,Henan China;Graduate School of Hunan University of Chinese Medicine,Changsha 410208,China)

机构地区：[1]河南中医药大学研究生院,郑州450046 [2]河南省洛阳正骨医院(河南省骨科医院) [3]湖南中医药大学研究生院

出　　处：《中国中医骨伤科杂志》2025年第1期78-83,共6页Chinese Journal of Traditional Medical Traumatology & Orthopedics

摘　　要：目的:回顾性分析应用单孔分体内镜(OSE)下腰椎间盘髓核切除术治疗单节段腰椎间盘突出症(LDH)的有效性及安全性。方法:2022年6月至2023年12月,33例患者因单节段腰椎间盘突出症接受在单孔分体内镜下腰椎间盘髓核切除术治疗。其中男18例,女15例;年龄为33~58岁,平均为(45.24±7.73)岁;体重指数为(24.25±1.66)kg/m^(2)。椎间盘突出责任节段:L3/4节段5例,L4/5节段15例,L5S1节段13例。记录切口长度、手术时间,统计所有患者手术前和术后3个月腰椎动力位X线片手术节段矢状面动力移位距离(ST)和活动度(ROM)。对所有患者术前、术后2 d、3个月及6个月采用疼痛视觉模拟量表(VAS)评分,日本骨科协会(JOA)评分进行评价,以评估其腰腿痛及腰椎功能恢复程度,术后随访6个月,采用改良MacNab标准评估临床疗效。结果:所有患者均顺利完成手术,切口长度平均为1.99 cm,手术时间平均为76.97 min。所有患者均完成至少半年随访,随访结果显示:术后3个月手术节段矢状面动力移位距离和活动度与术前比较差异均无统计学意义(P>0.05)。术后各时间节点患者腰腿部VAS评分和JOA评分较术前均有明显改善,各时间节点差异均有统计学意义(P<0.05)。末次随访时应用改良MacNab标准评估术后6个月临床疗效:优18例(54.55%),良12例(36.36%),可3例(9.09%),差0例,优良率为90.91%。结论:单孔分体内镜下腰椎间盘髓核切除术治疗单节段腰椎间盘突出症具有良好的有效性及安全性,可以作为其他脊柱内镜技术的替代选择,但远期疗效有待进一步研究证实。Objective:To retrospectively analyze the efficacy and safety of applying one-hole split endoscope(OSE)technique for the treatment of single-segment lumbar disc herniation(LDH).Methods:From June 2022 to December 2023,33 patients underwent lumbar disc nuclectomy with OSE technique for single-segment LDH,of which 18 were male and 15 were female,with ages ranging from 33 to 58 years old,with a mean age of(45.24±7.73)years old,a body mass index(BMI)of(24.25±1.66)kg/m^(2),and the responsible segments for disc herniation were:L3/4 segment in 5 cases,L4/5 segment in 15 cases,and L5S1 segment in 13 cases.The length of incision and operation time were recorded.The sagittal translation(ST)and range of motion(ROM)of the operated segments on lumbar power radiographs were counted in all patients before and 3 months after surgery.All patients were evaluated preoperatively,2 d after surgery,3 months after surgery,and 6 months after surgery using the visual analogue scale(VAS)score for pain,the Japanese orthopaedic association(JOA)scores to assess their lumbar and leg pain and lumbar spine function.The degree of recovery was evaluated to assess the degree of lumbar leg pain and lumbar spine function,and the modified MacNab criteria were used to assess the clinical efficacy at 6 months postoperatively.Results:All patients had successfully completed the surgery,with an average incision length of 1.99 cm,an average operation time of 76.97 min.All patients had completed at least half a year of follow-up,and the results of the follow-up showed that there was no statistically significant difference in the amount of ST of the operated segments and the ROM of the operated segments at 3 months after the surgery compared with those of the preoperative segments(P>0.05).The patients'VAS scores and JOA scores of the lumbar and leg at each postoperative time point were significantly improved compared with the preoperative ones,and the differences were statistically significant at each time point(P<0.05).At the final follow-up,the modified Ma

关 键 词：单孔分体内镜 单节段 腰椎间盘突出症 髓核切除术 

分 类 号：R681.5[医药卫生—骨科学]