经椎板间入路椎间孔镜技术治疗腰椎间盘突出症疗效分析

发布时间：2018-09-05 17:33

【摘要】：目的探讨经椎板间入路椎间孔镜技术治疗腰椎间盘突出症的临床疗效。方法采用经椎板间入路椎间孔镜TESSYS技术治疗54例腰椎间盘突出症患者(L4-5椎间盘突出13例、L5-S1椎间盘突出41例),分别于术前和术后1 d、3个月、1年时采用视觉模拟评分(VAS)和Oswestry功能障碍指数(ODI)评价手术前后疼痛改善情况,复查腰椎MRI评价髓核摘除情况和有无复发。结果 54例患者手术成功率为96.30%(52/54),其中2例术中出现硬脊膜破裂,改为手术显微镜下椎板开窗、髓核摘除术。平均手术时间58.35 min,中位住院时间3 d。出院时52例疼痛消失、2例疼痛减轻,其中5例患侧小腿外侧麻木感加重。与术前相比,术后1 d、3个月和1年时VAS和ODI评分均减少(均P=0.000)。术后复查腰椎MRI显示髓核摘除满意,神经根压迫解除,亦未见复发。无一例发生感染等手术相关并发症,1例L5-S1椎间盘突出患者因髓核脱出椎管内游离较远,术中对神经根牵拉较重,术后出现S1神经根分布区麻木,术后1个月缓解。结论经椎板间入路椎间孔镜技术治疗腰椎间盘突出症临床疗效满意、安全性良好。
[Abstract]:Objective to investigate the clinical effect of interlaminar approach for lumbar disc herniation. Methods 54 patients with lumbar disc herniation (L4-5 disc herniation, 13 patients with L5-S1 disc herniation) were treated by translaminar intervertebral foramen TESSYS technique. Visual analogue score was used before operation and 1 day, 3 months and 1 year after operation. (VAS) and Oswestry dysfunction index (ODI) were used to evaluate the pain improvement before and after operation. To evaluate the removal and recurrence of nucleus pulposus by MRI. Results the successful rate of operation was 96.30% (52 / 54) in 54 patients, 2 of them had rupture of dura mater, which was replaced by fenestration of vertebral lamina under operation microscope and excision of nucleus pulposus. The mean operative time was 58.35 min, and the median hospitalization time was 3 days. 52 cases of pain disappeared and 2 cases of pain were relieved at discharge, 5 cases of which had more numbness on the lateral side of the leg. VAS and ODI scores decreased at 1 day, 3 months and 1 year after operation (P < 0. 000). Lumbar MRI showed satisfactory removal of nucleus pulposus, release of nerve root compression and no recurrence. No infection was found in one patient with L5-S1 disc herniation due to prolapse of nucleus pulposus in the spinal canal, the nerve root was pulled more seriously during the operation, the distribution area of S1 nerve root was numb after operation, and the relief was achieved 1 month after operation. Conclusion the treatment of lumbar disc herniation by interlaminar approach is satisfactory and safe.
【作者单位】：首都医科大学宣武医院神经外科;
【分类号】：R687.3

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