全内镜经椎板间隙入路靶向治疗腰椎间盘突出症的手术策略及疗效分析

发布时间：2018-03-26 14:21

本文选题：经皮全内镜腰椎间盘切除术　切入点：靶向穿刺技术　出处：《遵义医学院》2017年硕士论文

【摘要】：目的:分析经皮全内镜经椎板间隙入路腰椎间盘切除术(Percutaneous Endoscopic Lumbar Discectomy,PELD)靶向治疗腰椎间盘突出症的手术策略、安全性和临床疗效。方法:收集2013年8月至2015年9月我院收治的单节段腰椎间盘突出患者69例,男29例,女40例,平均年龄45.4岁。根据突出间盘与受压神经根的位置关系分为肩上型间盘突出、腋下型间盘突出和肩前型间盘突出。所有患者行全内镜经椎板间隙入路靶向穿刺间盘切除术,其中肩上型突出采取肩上型穿刺路径,腋下型突出采用腋下型穿刺路径,肩前型突出采取肩前型穿刺路径。记录手术时间及髓核取出量,采用疼痛视觉模拟评分(Visual Analog Scale,VAS)、功能障碍指数(Oswestry Disability Index,ODI)及改良Macnab评分评定疗效。记录术前及术后1月、3月、6月、12月患者VAS评分、ODI评分。术后1周内复查腰椎MRI评估突出髓核摘除及神经根减压情况。结果:所有患者顺利完成手术,术中无明显出血,无神经组织损伤等相关并发症发生。平均手术时间88min,取出间盘组织平均体积2.8m L。术后1周内复查腰椎MRI均提示突出髓核摘除彻底、神经根减压充分。69例患者的随访时间为12个月。术前VAS评分为7.46±0.80分,术后12月时VAS评分为1.27±0.61分;术前ODI评分为(67.95±4.59)%,术后12月时ODI评分为(13.00±3.65)%,术后各时间点VAS评分和ODI评分均较术前明显降低,差异具有统计学意义(P0.05)。术后12月Macnab评分54例优,12例良,3例可,优良率95.6%。结论:通过恰当地选择肩上型穿刺路径、腋下型穿刺路径或肩前型穿刺路径行全内镜经椎板间隙入路靶向治疗腰椎间盘突出症,短期临床疗效满意,是一种安全、合理、有效的微创脊柱外科技术。
[Abstract]:Objective: to analyze the surgical strategy of percutaneous translaminar interlaminectomy for the treatment of lumbar disc herniation with percutanous Endoscopic Lumbar discectomyy (PELDD). Methods: from August 2013 to September 2015, 69 patients with single segment lumbar disc herniation were collected, including 29 males and 40 females. The mean age was 45.4 years. According to the relationship between the herniated disc and the compressed nerve root, the patients were divided into three groups: the herniation of the shoulder disc, the herniation of the subaxillary disc and the herniation of the anterior shoulder disc. The shoulder type protruding adopts the shoulder type puncture path, the axillary type protrusion adopts the axillary puncture path, the anterior shoulder type protrude adopts the anterior shoulder type puncture path. The operation time and the amount of the nucleus pulposus are recorded. Visual Analog scale score (VASI), dysfunction index (Oswestry Disability index) and modified Macnab score were used to evaluate the efficacy. The VAS scores were recorded before and 1 month, 3 months, 6 months and 12 months after operation. Lumbar MRI was evaluated within 1 week after operation. Results: all patients successfully completed the operation. There was no obvious bleeding, no nerve tissue injury and other related complications. The average operation time was 88 minutes, the average volume of intervertebral disc tissue was 2.8 mL. The MRI of lumbar vertebrae showed that protruding nucleus pulposus was removed thoroughly within 1 week after operation. The follow-up time of 69 patients with adequate nerve root decompression was 12 months. The VAS score was 7.46 卤0.80 before operation and 1.27 卤0.61 at 12 months after operation. The preoperative ODI score was 67.95 卤4.59g, the ODI score was 13.00 卤3.65g at 12 months after operation, and the VAS and ODI scores at each time point after operation were significantly lower than those before operation (P 0.05). The Macnab score in 54 cases was excellent in 12 cases and good in 3 cases at 12 months after operation. Conclusion: it is safe to treat lumbar intervertebral disc herniation by means of endoscopy through laminar space approach through the proper choice of shoulder puncture path, axillary puncture path or anterior shoulder puncture path. The short term clinical effect is satisfactory, and it is a safe method for the treatment of lumbar intervertebral disc herniation. Reasonable and effective minimally invasive spinal surgery technique.
【学位授予单位】：遵义医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.3

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