经皮椎间孔镜TESSYS技术治疗钙化型腰椎间盘突出症疗效分析
发布时间：2018-08-22 10:57
【摘要】：目的腰椎间盘突出症(lumber disc herniation)是由于腰椎间盘退变,纤维环破裂,髓核突出刺激或压迫神经根、马尾神经所表现出来的一系列临床症状和体征,是引起患者腰腿痛的主要原因。根据腰椎间盘突出的部位,可将腰椎间盘突出症分为三种类型,即中央型突出、后外侧型突出及椎间孔型突出；根据现代影像学检查,可将其分为膨出、突出、脱出和游离型。腰椎间盘突出症患者大多可经保守治疗缓解,然而,仍约有10%-20%的患者经保守治疗效果不理想,不能有效的缓解疼痛。尤其是伴钙化的腰椎间盘突出症患者,这一类型的腰椎间盘突出症不光指髓核或纤维环的钙化,还可累及到黄韧带、后纵韧带,压迫神经从而造成患者腰及相应节段所支配区域疼痛等症状。传统微创手术对此类患者效果欠佳,并且不宜行牵引及大的推拿,以免造成严重后果,加重病情。医学上传统观点认为这种钙化型椎间盘突出症需要做开窗手术,否则很难见效。但开窗手术创伤大、出血多,术后恢复时间长,术后常伴发腰椎不稳的风险,严重影响患者生活质量。随着医疗设备技术的发展与进步,脊柱微创手术被广泛应用于临床,较传统的开窗手术相比,脊柱微创手术具有创伤小、不良反应少、安全性高、目标直接、术后病人恢复迅速等优点。经皮椎间孔内镜TESSYS (transforaminal endoscopic spine system)技术,应用广泛,可用于很多种不同类型腰椎间盘突出症的治疗,譬如突出型、脱出型、游离型等,纤维环、髓核、骨性椎管狭窄、椎间孔狭窄、黄韧带肥厚等。然而,目前该技术治疗伴钙化型腰椎间盘突出症效果的研究非常少。因此,本研究通过对比分析不同患者通过椎间孔镜下TESSYS技术术后(3 d、1个月、3个月、6个月)治疗效果来探讨该技术治疗伴钙化型腰椎间盘突出症的疗效,以便该技术更好的应用于临床治疗,具有重要的临床意义。方法 自2014.2月至2014.9月,我科对伴钙化型腰椎间盘突出症患者48例行经后外侧入路椎间孔镜下TESSYS技术手术治疗,对每个病人都通过电话的方式进行了为期6个月的术后随访,分别比较术前、术后即刻、术后3 d、1个月、3个月、6个月的VAS、JOA、Oswestry功能障碍指数(ODI),最后一次电话随访评定患者的手术疗效时,应用改良的MacNab标准进行评定。结果本组48例患者,手术成功并获得随访,在48例患者中1例因术后未遵照医嘱严格卧床3 d,导致髓核再次脱出,遂再进行第2次手术,手术顺利；1例因同时患有终板炎,术后下肢放射性疼痛减轻,但仍感腰部疼痛较重,于术后第7日行椎间盘内注射三氧,手术顺利。其余患者手术均一次性顺利完成。48例患者手术后各时点与手术前相比,VAS评分、JOA评分均显著下降,Oswestry评分显著升高,差异有统计学意义(P0.05)；术后6个月与术后即刻、3d、1个月、3个月相比,VAS评分显著下降,JOA评分明显下降,Oswestry评分明显升高,差异有统计学意义(P0.05)；术后3个月与术后即刻、3d、1个月相比,差异无统计学意义(P0.05)；术后1个月与术后即刻、3d相比,差异无统计学意义(P0.05)；术后3d与术后即刻相比,差异无统计学意义(P0.05)。说明椎间孔镜治疗钙化型腰椎间盘突出症有效,且术后6月效果较好。末次随访应用改良MacNab标准评价患者的临床疗效,21例(43.75%),良23例(47.91%),可4例(8.34%),差0例,优良率91.47%(44/48)。结论经皮椎间孔镜下TESSYS技术治疗伴钙化型腰椎间盘突出症安全、有效、创伤小、不良反应少,且术后6个月效果较好。
[Abstract]:Objective Lumbar disc herniation is a series of clinical symptoms and signs caused by degeneration of lumbar intervertebral disc, rupture of annulus fibrosus, protrusion of nucleus pulposus stimulating or compressing nerve root and cauda equina nerve, which is the main cause of low back and leg pain. There are three types of lumbar disc herniation: central herniation, posterolateral herniation and intervertebral foramen herniation. According to modern imaging examination, it can be divided into herniation, protrusion, prolapse and free type. Pain. Especially in patients with calcified lumbar disc herniation, this type of lumbar disc herniation not only refers to nucleus pulposus or annulus fibrosus calcification, but also involves ligamentum flavum, posterior longitudinal ligament, compression of nerves, resulting in the patient's lumbar and corresponding segmental areas of pain and other symptoms. Traditional minimally invasive surgery for such patients is not effective, and not. Traditionally, this calcified disc herniation requires fenestration, otherwise it is difficult to achieve results. However, fenestration surgery is traumatic, bleeding, postoperative recovery time is long, often accompanied by the risk of lumbar instability, seriously affecting the quality of life of patients. With the development and progress of medical equipment technology, spinal minimally invasive surgery is widely used in clinic. Compared with traditional fenestration surgery, spinal minimally invasive surgery has the advantages of less trauma, fewer adverse reactions, high safety, direct target and rapid recovery. It is widely used in the treatment of many different types of lumbar disc herniation, such as herniation, prolapse, dissociation, annulus fibrosus, nucleus pulposus, osseous spinal canal stenosis, intervertebral foramen stenosis, ligamentum flavum hypertrophy, etc. However, there are very few studies on the effect of this technique in the treatment of calcified lumbar disc herniation. To analyze the therapeutic effect of TESSYS on different patients with calcified lumbar intervertebral disc herniation after operation (3 days, 1 month, 3 months, 6 months) by foraminoscope, so as to better apply the technique to clinical treatment, which has important clinical significance. Methods From February 2014 to September 2014, our department treated the patients with calcified lumbar intervertebral disc herniation. Forty-eight patients with disc herniation underwent TESSYS via posterolateral approach. Each patient was followed up by telephone for 6 months. VAS, JOA, Oswestry Dysfunction Index (ODI) were compared preoperatively, immediately after surgery, 3 days, 1 month, 3 months and 6 months after surgery, and the final telephone follow-up was evaluated. Results Forty-eight patients were successfully operated on and followed up. Among them, one patient failed to follow the doctor's instructions and stayed in bed for 3 days after operation, resulting in the nucleus pulposus prolapse again. The second operation was performed successfully. One patient suffered from endplate inflammation and postoperative radiation pain of lower extremity. The rest of the patients completed the operation smoothly at one time. VAS and JOA scores of 48 patients decreased significantly at each time point after operation, while Oswestry scores increased significantly (P 0.05). VAS score decreased significantly, JOA score decreased significantly, Oswestry score increased significantly (P 0.05) immediately after surgery, 3 days, 1 month, compared with 3 months after surgery, there was no significant difference (P 0.05); 1 month after surgery, compared with immediately after surgery, 3 days, 1 month after surgery, there was no significant difference (P 0.05); There was no significant difference between the latter three days and the immediate postoperatively (P 0.05). The results showed that the treatment of calcified lumbar disc herniation with intervertebral foraminoscopy was effective and effective 6 months after operation. At the last follow-up, 21 cases (43.75%), 23 cases (47.91%) were good, 4 cases (8.34%) were fair, 0 cases were poor, and the excellent and good rate was 91.47% (44/48). TESSYS is a safe, effective, minimally invasive and safe technique for the treatment of lumbar disc herniation with calcification.
【学位授予单位】：滨州医学院
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.3
[Abstract]:Objective Lumbar disc herniation is a series of clinical symptoms and signs caused by degeneration of lumbar intervertebral disc, rupture of annulus fibrosus, protrusion of nucleus pulposus stimulating or compressing nerve root and cauda equina nerve, which is the main cause of low back and leg pain. There are three types of lumbar disc herniation: central herniation, posterolateral herniation and intervertebral foramen herniation. According to modern imaging examination, it can be divided into herniation, protrusion, prolapse and free type. Pain. Especially in patients with calcified lumbar disc herniation, this type of lumbar disc herniation not only refers to nucleus pulposus or annulus fibrosus calcification, but also involves ligamentum flavum, posterior longitudinal ligament, compression of nerves, resulting in the patient's lumbar and corresponding segmental areas of pain and other symptoms. Traditional minimally invasive surgery for such patients is not effective, and not. Traditionally, this calcified disc herniation requires fenestration, otherwise it is difficult to achieve results. However, fenestration surgery is traumatic, bleeding, postoperative recovery time is long, often accompanied by the risk of lumbar instability, seriously affecting the quality of life of patients. With the development and progress of medical equipment technology, spinal minimally invasive surgery is widely used in clinic. Compared with traditional fenestration surgery, spinal minimally invasive surgery has the advantages of less trauma, fewer adverse reactions, high safety, direct target and rapid recovery. It is widely used in the treatment of many different types of lumbar disc herniation, such as herniation, prolapse, dissociation, annulus fibrosus, nucleus pulposus, osseous spinal canal stenosis, intervertebral foramen stenosis, ligamentum flavum hypertrophy, etc. However, there are very few studies on the effect of this technique in the treatment of calcified lumbar disc herniation. To analyze the therapeutic effect of TESSYS on different patients with calcified lumbar intervertebral disc herniation after operation (3 days, 1 month, 3 months, 6 months) by foraminoscope, so as to better apply the technique to clinical treatment, which has important clinical significance. Methods From February 2014 to September 2014, our department treated the patients with calcified lumbar intervertebral disc herniation. Forty-eight patients with disc herniation underwent TESSYS via posterolateral approach. Each patient was followed up by telephone for 6 months. VAS, JOA, Oswestry Dysfunction Index (ODI) were compared preoperatively, immediately after surgery, 3 days, 1 month, 3 months and 6 months after surgery, and the final telephone follow-up was evaluated. Results Forty-eight patients were successfully operated on and followed up. Among them, one patient failed to follow the doctor's instructions and stayed in bed for 3 days after operation, resulting in the nucleus pulposus prolapse again. The second operation was performed successfully. One patient suffered from endplate inflammation and postoperative radiation pain of lower extremity. The rest of the patients completed the operation smoothly at one time. VAS and JOA scores of 48 patients decreased significantly at each time point after operation, while Oswestry scores increased significantly (P 0.05). VAS score decreased significantly, JOA score decreased significantly, Oswestry score increased significantly (P 0.05) immediately after surgery, 3 days, 1 month, compared with 3 months after surgery, there was no significant difference (P 0.05); 1 month after surgery, compared with immediately after surgery, 3 days, 1 month after surgery, there was no significant difference (P 0.05); There was no significant difference between the latter three days and the immediate postoperatively (P 0.05). The results showed that the treatment of calcified lumbar disc herniation with intervertebral foraminoscopy was effective and effective 6 months after operation. At the last follow-up, 21 cases (43.75%), 23 cases (47.91%) were good, 4 cases (8.34%) were fair, 0 cases were poor, and the excellent and good rate was 91.47% (44/48). TESSYS is a safe, effective, minimally invasive and safe technique for the treatment of lumbar disc herniation with calcification.
【学位授予单位】：滨州医学院
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.3
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