经部分椎弓根入路经皮内镜治疗高度向下游离型腰椎间盘突出症

发布时间：2018-08-22 18:56

【摘要】：目的:探讨经皮内镜下通过部分椎弓根入路,治疗高度向下游离型腰椎间盘突出症的可行性和安全性,观察临床治疗效果。方法:选择2014年7月至2016年1月我院收治的共21例高度向下游离型腰椎间盘突出症患者(其中L3/4 3例,L4/5 15例,L5/S1 3例),保守治疗3周效果不佳。经皮脊柱内镜下,磨除部分椎弓根,摘除高度游离的椎间盘髓核组织,解除神经根压迫。统计手术时间和手术相关并发症。通过术前和术后视觉模拟评分(Visual analog scale,VAS)评分、功能障碍指数(Oswestry disability index,ODI)评估患者术后改善情况,使用改良Macnab疗效评定标准评估手术疗效。结果:所有患者均成功实施手术,手术时间93±10min。1例患者术后第1天出现下肢神经感觉异常,经保守治疗后症状缓解;无感染、神经血管损伤、硬脊膜撕裂等并发症出现。随访12个月,VAS术前7.57±1.09分,术后1天2.90±0.52分,术后1月2.24±0.52分,术后3月1.86±0.63分,术后6月1.38±0.48分,术后12月1.19±0.49分,与术前比较均有显著性差异(p0.01);ODI评分由术前(54.86±12.67)%减少到术后12月时(11.80±1.73)%,与术前比较均有显著性差异(p0.01)。根据改良Macnab评估标准,术后12月时优15例,良4例,可2例,差0例,术后优良率为90.47%。结论:经部分椎弓根入路经皮内镜下腰椎间盘切除术治疗高度向下游离型椎间盘突出症是一种安全、可行、有效的治疗方法。
[Abstract]:Objective: to investigate the feasibility and safety of percutaneous endoscopic approach for the treatment of highly downstream lumbar disc herniation through partial pedicle approach. Methods: from July 2014 to January 2016, 21 patients with highly downstream protrusion of lumbar intervertebral disc (L3 / 43, L4 / 5 / 515, L5 / S1, 3 cases) were treated in our hospital. The results of conservative treatment for 3 weeks were not good. Under percutaneous spinal endoscopy, partial pedicle was removed, nucleus pulposus tissue was removed and nerve root compression was relieved. The time of operation and the complications associated with the operation were calculated. Preoperative and postoperative visual analogue score (Visual analog scale( Visual analog), dysfunction index (Oswestry disability) were used to evaluate the postoperative improvement, and modified Macnab evaluation criteria were used to evaluate the outcome of the operation. Results: all the patients were successfully operated. The operation time was 93 卤10min.1, the first day after operation, the lower extremity nerve sensation was abnormal, the symptoms were relieved after conservative treatment, no infection, nerve and blood vessel injury, dural tear and other complications occurred. VAS was followed up for 12 months (7.57 卤1.09, 2.90 卤0.52, 2.24 卤0.52, 1.86 卤0.63, 1.38 卤0.48 and 1.19 卤0.49, respectively). The ODI scores decreased from (54.86 卤12.67)% to (11.80 卤1.73) 12 months after operation (p0.01). According to the modified Macnab evaluation criteria, 15 cases were excellent at 12 months after operation, 4 cases were good, 2 cases were fair, and 0 cases were poor. The excellent and good rate was 90.47%. Conclusion: percutaneous endoscopic lumbar discectomy via partial pedicle approach is a safe, feasible and effective method for the treatment of highly downstream disc herniation.
【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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