经皮内镜联合非融合内固定技术治疗巨大腰椎间盘突出症的初步临床研究

发布时间：2018-05-30 22:30

本文选题：巨大腰椎间盘突出 + 经皮内镜下腰椎间盘髓核摘除术　；参考：《重庆医科大学》2017年硕士论文

【摘要】：目的:探讨经皮内镜下腰椎间盘髓核摘除术(Percutaneous endoscopic lumbar discectomy,PELD)联合微创通道PEEK半刚性固定棒非融合固定技术治疗巨大腰椎间盘突出(Huge lumbar disc herniation,HLDH)的可行性、安全性及初步临床疗效。方法:纳入2014年6月--2015年10月HLDH患者共21例,并全部给予PELD联合微创通道PEEK半刚性固定棒非融合固定术治疗。术前及术后各时间点的腰腿和腿痛视觉模拟评分(Visual analog scale,VAS)被记录,术前及末次随访Oswestry功能障碍指数评分(Oswestry disability index,ODI)、末次改良Mac Nab疗效评定标准被记录。结果:21例患者均全部成功完成手术。平均手术时间为189.8±50.6min。平均术中失血量为102.4±88.7 ml。平均住院时间为9±3.1 d。随访7月~22月,平均13±4.1月。与术前相较,术后3月、6月及末次腰痛VAS评分改善明显。与术前相较,术后第1天、1月、3月、6月及末次腿痛VAS评分改善明显。与术前相较,术后第1天腰痛VAS评分有所增加。与术前相较,术后1月腰痛VAS评分统计学下无明显差异。与术前相较,末次随访ODI评分较术前有明显改善。末次改良Mac Nab疗效评定标准:优18例,良2例,可1例。末次随访时无患者复发。结论:通过对PELD联合微创通道PEEK半刚性固定棒非融合固定术治疗HLDH的初步分析,该手术在技术上是安全可行的,有着令人满意的短期临床疗效。但由于随访时间偏短且缺少与传统标准融合固定等手术方式的对比,该技术远期疗效有待更进一步的深入的研究。
[Abstract]:Objective: to investigate the feasibility, safety and preliminary clinical effect of percutaneous endoscopic discectomy of endoscopic lumbar discectomyn (PELDD) combined with minimally invasive channel PEEK semi-rigid rod nonfusion fixation in the treatment of giant lumbar disc herniation. Methods: a total of 21 patients with HLDH from June 2014 to October 2015 were enrolled and all were treated with PELD combined with minimally invasive channel PEEK semi-rigid fixed rod non-fusion fixation. Visual analog scale was recorded at all time points before and after operation. Oswestry disability index was evaluated before and at the last follow-up, and the last modified Mac Nab evaluation standard was recorded. Results all 21 cases were successfully operated. The mean operative time was 189.8 卤50.6 min. The average intraoperative blood loss was 102.4 卤88.7 ml. The average hospitalization time was 9 卤3.1 days. The follow-up ranged from 7 months to 22 months, with an average of 13 卤4.1 months. Compared with preoperative, the VAS scores of 3 months, 6 months and the last time of low back pain improved significantly. The VAS scores of leg pain on the first day, one month, three months, six months and the last time after operation were significantly improved compared with those before operation. Compared with preoperative, the VAS score of low back pain increased on the first day after operation. There was no significant difference in VAS score of low back pain between before and after operation. The ODI score of the last follow-up was significantly improved compared with that before operation. The last modified Mac Nab evaluation criteria were excellent in 18 cases, good in 2 cases and fair in 1 case. No recurrence occurred at the last follow-up. Conclusion: through the preliminary analysis of PELD combined with minimally invasive PEEK semi-rigid fixed rod non-fusion fixation for HLDH, the operation is technically safe and feasible, and has a satisfactory short-term clinical effect. However, due to the short follow-up time and the lack of comparison with the traditional standard fusion and fixation, the long-term effect of this technique needs further in-depth study.
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.3

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