多节段腰椎间盘突出责任节段的定位及椎间孔镜下治疗的疗效观察

发布时间：2018-11-26 19:44

【摘要】：目的:探讨多节段腰椎间盘突出的责任节段的定位方法及椎间孔镜下治疗的疗效观察。方法:从2014年1月至2015年12月,对收治的共32例多节段腰椎间盘突出患者,其中男性18例,女性14例;年龄49~77岁,平均58岁,所有病例均采用选择性神经根封闭术定位责任节段,其中27例患者再据责任节段行椎间孔镜下治疗。术前、术后均采用日本骨科协会(Japanese orthopaedic association.JOA)评分及视觉模拟疼痛评分法(visual analoguescale,VAS)评分对手术效果进行评估。结果:选择神经根封闭术后有5例患者未再行椎间孔镜下治疗,其中有3例患者疼痛减轻不明显,暂不行微创手术;另外2例患者症状明显减轻,拒绝进一步手术。27例患者均顺利完成手术,无感染、神经根损伤等并发症,所有患者术后随访,观察术后1个月、3个月、6个月,VAS评分较术前均明显降低(P0.05),JOA评分较术前均明显增高(P0.05),差异有统计学意义。结论:对于多节段腰椎间盘突出,先选择神经根封闭术明确责任节段,再行椎间孔镜下治疗能有效缓解患者症状,且手术创伤小,并发症少。
[Abstract]:Objective: to investigate the localization method of multiple segment lumbar disc herniation and the curative effect of intervertebral foramen endoscopy. Methods: from January 2014 to December 2015, 32 patients with multilevel lumbar disc herniation were treated, including 18 males and 14 females. The age was 4977 years (mean 58 years). All the patients were treated with selective nerve root closure to locate the responsible segment. 27 patients were treated with intervertebral foramen according to the responsible segment. Preoperative and postoperative results were evaluated by Japanese Orthopaedic Association (Japanese orthopaedic association.JOA) score and visual analogue pain score (visual analoguescale,VAS). Results: 5 patients were not treated with intervertebral foramen after nerve root closure, 3 of them had no obvious pain relief and could not perform minimally invasive surgery for the time being. The other 2 patients were obviously relieved and refused further operation. All the 27 patients were successfully operated without infection and nerve root injury. All the patients were followed up 1 month, 3 months, 6 months after operation, and 1 month, 3 months, 6 months after operation. VAS scores were significantly lower than those before operation (P0.05), JOA scores were significantly higher than before (P0.05), the difference was statistically significant. Conclusion: for multisegmental lumbar disc herniation, the first choice of nerve root closure is responsible segment, then the treatment under intervertebral foramen can effectively relieve the symptoms of the patients, and the surgical trauma is small, and the complications are less.
【作者单位】：广西中医药大学;广西中医药大学附属瑞康医院;
【分类号】：R687.3

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