经皮脊柱内镜椎板间入路治疗特殊类型腰椎间盘突出症的临床研究

发布时间：2018-06-04 03:11

本文选题：经皮内窥镜 + 椎板间入路　；参考：《南昌大学》2017年硕士论文

【摘要】：背景及目的经皮脊柱内镜椎板间入路椎间盘切除术治疗腰椎间盘突出症取得了良好的效果,其优势在于局部麻醉下手术,直视下充分暴露神经组织完成减压,未损伤腰椎稳定性结构,感染和出血少,恢复较快,该技术对于特殊类型的腰椎间盘突出症,例如钙化型及脱垂游离型腰椎间盘突出症的治疗效果尚不明确。本研究评估了经皮脊柱内镜椎板间入路及改良技术对于钙化型和脱垂游离型腰椎间盘突出症的治疗效果。第一部分方法:收集了2013年11月至2016年3月在南昌大学第二附属医院骨科接受经皮脊柱内镜椎板间椎间盘切除术(PEID)的患者的资料。其中20例钙化型腰椎间盘突出症患者纳入研究组(平均年龄43岁,30-59岁),20例年龄,性别和体重指数(BMI)与非钙化型腰椎间盘突出症相匹配的病例作为对照(平均年龄40岁,22-58岁)。收集围手术期数据术前和术后3、6、12个月视觉模拟评分法(VAS),Oswestry功能障碍指数(ODI),应用改良Mac Nab标准判定疗效,通过腰椎CT评价钙化病灶术后12个月的变化情况。结果:两组40例患者,手术成功并获得随访。两组患者性别,年龄,BMI和病变节段差异无统计学意义(P0.05)。CLDH组手术时间明显长于NCLDH组,差异有统计学意义(P0.05)。手术后患者腰痛及下肢疼痛的不适症状立即缓解。两组术前、术后VAS和ODI评分差异均有统计学意义(P0.01),两组患者VAS评分各时间点差异无统计学意义(P0.05),但术后早期NCLDH组VAS评分略好于CLDH组(P0.05),NCLDH组各时间点ODI评分略好于CLDH组,差异无统计学意义(P0.05)。CLDH组和NCLDH组在最终随访中Mac Nab优良的结果百分比分别为90%和95%,组间差异无统计学意义(P0.05)。术前及术后各时间点CLDH组出现感觉异常的患者病历均多于NCLDH组,差异无统计学意义(P0.05)。术后通过腰椎CT的评价,短期内椎间盘未再次发现明显的钙化病灶。第二部分方法:2013年11月至2016年3月根据Lee分级的高度脱垂游离的腰椎间盘突出症(1-4区)患者15例纳入研究,8例男性患者以及7例女性患者(平均年龄41岁,22-56岁),L4/L5间隙5例,L5/S1间隙10例。收集围手术期数据术前和术后3、6、12个月视觉模拟评分法(VAS),Oswestry功能障碍指数(ODI),应用改良Mac Nab标准判定疗效。结果:15例患者顺利完成手术,术后下肢痛均立即消失,无神经根损伤、术后出血及硬膜破裂等并发症,手术时间50-72min平均60min。术后3、6及12个月VAS评分、ODI指数与术前比较均有显著性差(P0.01),术后各时间点间比较无显著性差异(P0.05)。按照Mac Nab评价标准,优良率93.3%(14/15)。结论经皮脊柱内镜椎板间入路及其改良技术对于治疗特殊类型的腰椎间盘突出症有良好的临床疗效,特别是对于治疗钙化型及脱垂游离型腰椎间盘突出症,安全、有效、创伤小,短期内临床疗效较好,其远期疗效还需进一步的临床研究。
[Abstract]:Background and objective Percutaneous endoscopic interlaminectomy for the treatment of lumbar disc herniation has achieved good results, its advantage lies in local anesthesia surgery, full exposure of nerve tissue under direct vision to complete decompression. The effect of this technique on the treatment of special types of lumbar disc herniation such as calcified and prolapsed free lumbar disc herniation is not clear. This study evaluated the efficacy of percutaneous endoscopic interlaminar approach and modified technique in the treatment of calcified and prolapse free lumbar disc herniation. Methods: from November 2013 to March 2016, data were collected from patients undergoing percutaneous endoscopic interlaminectomy of vertebral disc (PEIDD) in the Department of Orthopaedics, second affiliated Hospital of Nanchang University. Twenty patients with calcified lumbar disc herniation (mean age of 43 years, 30 to 59 years old) and non-calcified lumbar disc herniation patients (mean age 40 years, 22 to 58 years old) were included in the study group (mean age, 43 years, 30 to 59 years old) and matched with non-calcified lumbar disc herniation (mean age, 40 years and 22 to 58 years old). The data of perioperative period were collected before and after operation. The visual analogue score was used to evaluate the Oswestry dysfunction index in 12 months. The modified Mac Nab criterion was used to evaluate the curative effect. The changes of calcified lesions were evaluated 12 months after operation by lumbar CT. Results: 40 patients in both groups were operated successfully and followed up. There was no significant difference between the two groups in terms of sex, age and lesion segment. The operative time of the two groups was significantly longer than that of the NCLDH group, and the difference was statistically significant (P 0.05). The symptoms of low back pain and lower extremity pain were relieved immediately after operation. There were significant differences in VAS and ODI scores between the two groups before and after operation (P 0.01). There was no significant difference in VAS scores between the two groups at each time point. However, the VAS score in the early postoperative NCLDH group was slightly better than that in the CLDH group at each time point, and the ODI score was slightly better in the early postoperative NCLDH group than in the CLDH group. There was no significant difference in the percentage of excellent results of Mac Nab between the two groups in the final follow-up (90%) and in the NCLDH group (95%). There was no significant difference between the two groups (P 0.05). The patients with abnormal sensation in CLDH group were more than those in NCLDH group at each time point before and after operation, the difference was not statistically significant (P 0.05). After the lumbar spine CT evaluation, no significant calcification lesions were found in the intervertebral disc in a short period of time. Methods: from November 2013 to March 2016, 15 patients with highly prolapse of lumbar intervertebral disc herniation (zone 1-4) according to the Lee classification were included in the study of 8 male patients and 7 female patients (mean age 41 years, 22 to 56 years old). There were 5 cases of L 5 / S 1 space in 5 cases. The data of perioperative period were collected before and after operation. The visual analogue scoring method was used to evaluate the efficacy of VAS-Oswestry dysfunction index. The modified Mac Nab criterion was used to evaluate the efficacy. Results the operation was successfully completed in 15 cases. The pain of lower extremity disappeared immediately. There were no complications such as nerve root injury, postoperative hemorrhage and dural rupture. The average operation time of 50-72min was 60 minutes. There was significant difference in VAS scores between 3 months and 12 months after operation (P 0.01), but there was no significant difference between different postoperative time points (P 0.05). According to Mac Nab criteria, the excellent and good rate was 93. 3%. Conclusion Percutaneous endoscopic interlaminar approach and its modified technique are safe and effective in the treatment of special types of lumbar disc herniation, especially in the treatment of calcified and prolapsed lumbar disc herniation. Small trauma, short-term clinical effect is better, its long-term effect needs further clinical research.
【学位授予单位】：南昌大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.3

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