经皮椎间孔镜技术治疗青少年腰椎间盘突出症的疗效分析

发布时间：2018-03-14 15:24

本文选题：经皮椎间孔镜技术　切入点：腰椎间盘突出症　出处：《昆明医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：[目的]探讨经皮椎间孔镜技术治疗青少年腰椎间盘突出症(Lumbar Disc Herniation, LDH)的临床疗效。[方法]选择从2013年9月至2016年3月昆明医科大学附属延安医院脊柱外科采用经皮椎间孔镜下髓核摘除术(Percutaneous Endoscopic Lumbar Discectomy,PELD)治疗青少年腰椎间盘突出症的病例共19例,收集患者相关数据包括:手术时间、手术切口长度、术中出血量及住院时间,采用腰痛及下肢痛综合视觉模拟法(Visual Analogue Scale,VAS)评分与日本骨科协会评估治疗腰椎(Japanese Orthopaedic Association,JOA)分数分别于术前、术后第7天、术后3个月及术后12个月,比较治疗前后的疗效差异,并根据术后12个月的改良Macnab评分对临床疗效进行评价。[结果]所有19例手术均顺利完成,均未产生术后并发症。手术时间平均54.3分钟,手术切口长度平均0.7cm,术中出血量平均8ml,住院时间4～10平均6天。所有患者在术后3个月及术后12个月均获得随访,随访期间均未发现手术相关并发症。腰痛及下肢痛综合VAS评分术前为(7.00±0.86),术后第7天为(2.05±0.69),术后 3 个月为(1.11±0.64),术后 12 个月为(0.63±0.58),术后与术前相比,差异具有统计学意义(P0.05);腰椎JOA分数术前为(9.37±0.98),术后第7天为(16.58±1.39),术后3个月为(22.95±1.05),术后12个月为(26.74±0.85),术后与术前相比,差异具有统计学意义(P0.05)。术后第7天时JOA分数改善率(%)为(37.18±7.23),19例均为有效;术后3个月时改善率(%)为(69.12±5.39),18例显效,1例有效;术后12个月时改善率(%)为(88.42±4.49),19例均为显效。根据术后12个月的改良Macnab评分评价临床疗效,共19例中,11例为优(57.9%),8例为良(42.1%),优良率为100%。[结论]1.经皮椎间孔镜下髓核摘除术(PELD)是治疗青少年腰椎间盘突出症(LDH)的安全、有效的手术方式。2. PELD治疗青少年LDH的远期疗效及复发率以及对青少年生长发育的影响情况仍需要更多临床观察以及更深入的研究。
[Abstract]:[objective] to evaluate the clinical efficacy of percutaneous foramen technique in the treatment of lumbar disc herniation (Lumbar Disc herniation) in adolescents. [methods] from September 2013 to March 2016, the spinal surgery of Yan'an Hospital affiliated to Kunming Medical University was selected for the treatment of lumbar intervertebral disc herniation. 19 cases of juvenile lumbar disc herniation were treated by percutaneous transhepatic Endoscopic Lumbar discectomy1 (PELDD). The data collected include the operation time, the length of the incision, the amount of blood lost during the operation and the length of hospital stay. Visual Analogue scale scale score was used to evaluate the scores of Japanese Orthopaedic Association and Japanese Orthopedic Association before operation, 7 days after operation, 3 months after operation and 12 months after operation, respectively. The clinical efficacy was evaluated according to the modified Macnab score 12 months after operation. [results] all the 19 cases were successfully completed without postoperative complications. The average operation time was 54.3 minutes. The average length of incision was 0.7 cm, the average amount of blood lost during operation was 8 ml, and the average hospital stay was 4 ~ 10 days. All the patients were followed up at 3 months and 12 months after operation. The VAS scores of low back pain and lower extremity pain were 7.00 卤0.86 before operation, 2.05 卤0.69 on the 7th day, 1.11 卤0.64 at 3 months after operation and 0.63 卤0.58 at 12 months after operation. The JOA score of lumbar vertebrae was 9.37 卤0.98 before operation, 16.58 卤1.39 on the 7th day after operation, 22.95 卤1.05 at 3 months after operation and 26.74 卤0.85 at 12 months after operation. The difference was statistically significant (P 0.05). On the 7th day after operation, the improvement rate of JOA score was significantly higher in 19 cases than that in the control group (37.18 卤7.23%), and at 3 months after operation, the improvement rate was 69.12 卤5.39% in 18 cases and effective in 1 case. At 12 months after operation, the improvement rate was 88.42 卤4.49%. The clinical efficacy was evaluated according to the modified Macnab score at 12 months after operation. Among the 19 cases, 11 cases were excellent 57.9% and 8 cases were good, the excellent and good rate was 100. [conclusion] 1.Percutaneous transforaminal discectomy with PELDD was safe for the treatment of juvenile lumbar disc herniation. The long-term effect and recurrence rate of PELD in the treatment of adolescent LDH and its influence on adolescent growth and development still need more clinical observation and further study.
【学位授予单位】：昆明医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R726.8

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