经椎间孔入路和经椎板间入路内镜下腰椎间盘切除术治疗L5-S1椎间盘突出疗效比较

发布时间：2018-03-11 00:12

本文选题：PELD　切入点：L5-S1椎间盘突出　出处：《浙江大学》2016年硕士论文　论文类型：学位论文

【摘要】：目的：本研究的目的是通过比较已行TF-PELD和IL-PELD治疗的L5-S1椎间盘突出患者的影像学特征和治疗效果,来阐述L5-S1椎间盘突出患者PELD手术通路的选择标准。方法：对在我院行TF-PELD和IL-PELD治疗的50位L5-S1椎间盘突出病人进行回顾性分析,术前术后均行MRI及X线片检查。对椎间盘类型、大小、位置、是否迁移、椎间盘高度、椎间孔高度、髂骨高度和椎板间高度进行比较分析。对随访时间满1年的患者予量表收集评估临床疗效。术前术后均采用疼痛视觉类比评分(visual analogue scale,VAS)来测量评估患者疼痛,用Oswestry功能障碍指数(oswestry disability index,ODI)和回归工作时间间隔来评估患者功能情况。结果：两组病人术后VAS评分和ODI评分较术前都有显著性提高,而两组间腰背部和腿部VAS评分以及ODI评分比较都没有显著性差异.TF-PELD组平均回归工作间隔时间为4.7±2.4周,IL-PELD组为4.2±1.5周。1年随访结果显示,TF-PELD组无一病人出现腰椎间盘复发、感觉异常或出行神经损伤症状,而IL-PELD组有1位病人复发,并且有2位病人出现术后局部感觉异常。两组病人回归工作时间、复发率相比都无显著性差异。TF-PELD和IL-PELD两组间在椎间盘类型、移位程度和椎间盘位置等方面具有显著性差异。在IL-PELD组中,腋下型椎间盘比例(17例,68%)高于肩上型(8例,32%)。另一方面,TF-PELD组肩上型(18例,72%)发病率比腋下型(7例,28%)高(P=0.01)。TF-PELD组(8例,32%)的中央型椎间盘突出发病率比IL-PELD组(2例,8%)高(P=0.01)。9例(36%)高度移位病例接受了IL-PELD,而只有1(4%)例行TF-PELD(P=0.01)。2例复发性腰椎间盘突出病人成功行TF-PELD取出突出的椎间盘。反应髂骨和L5-S1椎间盘解剖关系的影像学指标在两组间均无显著性差异。结论：该研究表明TF—PELD对于肩上型、中央型和复发的腰椎间盘突出疗效更好,而IL-PELD对腋下型和游离型突出椎间盘具有优势,对于迁移程度高的游离型突出椎间盘来说,IL-PELD比TF-PELD更为适合。
[Abstract]:Objective: to compare the imaging features and therapeutic effects of L5-S1 disc herniation patients who have been treated with TF-PELD and IL-PELD. Methods: 50 patients with L5-S1 disc herniation treated by TF-PELD and IL-PELD in our hospital were analyzed retrospectively. MRI and X-ray examination were performed before and after operation. Size, location, migration, disc height, intervertebral foramen height, The height of iliac bone and the height of vertebral lamina were compared and analyzed. The clinical curative effect was evaluated by collecting and evaluating the clinical efficacy of the patients who had been followed up for more than one year. The pain was evaluated by visual analogue scale scale before and after operation. The functional status of patients was evaluated by Oswestry dysfunction index (Oswestry) and regression time interval. Results: the VAS score and ODI score of the two groups were significantly higher than those before operation. However, there was no significant difference in VAS score and ODI score between the two groups. The average regression interval was 4.7 卤2.4 weeks in the TF-PELD group and 4.2 卤1.5 weeks in the IL-PELD group. The results of 1-year follow-up showed that none of the patients in the TF-PELD group had recurrence of lumbar intervertebral disc. In the IL-PELD group, 1 patient recurred and 2 patients had postoperative local sensory abnormalities. The patients in both groups returned to work time. There was no significant difference in recurrence rate between TF-PELD and IL-PELD. There were significant differences in disc type, displacement and disc location between TF-PELD and IL-PELD groups. The incidence of central disc herniation in the TF-PELD group was higher than that in the TF-PELD group (n = 8). The incidence of central disc herniation in the TF-PELD group was higher than that in the IL-PELD group (n = 2, n = 8). On the other hand, the incidence of central disc herniation in the TF-PELD group was higher than that in the TF-PELD group (n = 18, n = 18, n = 72). The incidence of central disc herniation in the TF-PELD group was higher than that in the TF-PELD group (n = 8). The patients with degree shift received IL-PELDD, but only 1 out of 4 patients were treated with TF-PELD(P=0.01).2. Patients with recurrent lumbar intervertebral disc herniation were successfully removed by TF-PELD. There was no significant difference in the imaging parameters of the anatomical relationship between iliac bone and L5-S1 disc in both groups. Conclusion: this study shows that TF-PELD is associated with shoulder type, Central and recurrent lumbar disc herniation were more effective, while IL-PELD had advantages in axillary and free intervertebral disc herniation, and IL-PELD was more suitable for free disc herniation with high migration degree than TF-PELD.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R687.3

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