硬膜外游离型腰椎间盘突出症的手术方式探讨

发布时间：2019-01-26 18:06

【摘要】：[目的]依据游离髓核位置的分型与分区,探讨摘除硬膜外游离椎间盘的手术方式并评估经皮内窥镜下腰椎间盘切除术(PELD)、椎板开窗髓核摘除术(FD)治疗硬膜外游离型腰椎间盘突出症的手术疗效。[方法]回顾性分析本科2013年8月~2015年3月收治的此类患者37例,FD组:16例,其中5例髓核游离于1、4区的患者采用扩大开窗髓核摘除术;11例2、3区的患者采用常规FD手术。PELD组:共21例,其中4例髓核游离于1、4区的患者采用经对侧椎间孔镜腰椎间盘切除术(c-PTED);17例2、3区的患者应用了常规的经同侧椎间孔镜腰椎间盘切除术(i-PTED)。采用视觉模拟量表(VAS)评分、改良Macnab分级标准、Oswestry功能障碍指数(ODI)评定手术疗效,统计并比较两组在手术时间、出血量及术后住院时间上的差异。[结果]两组患者均得到完整随访,随访时间15~18个月,平均16.3个月。术后下肢疼痛VAS评分及ODI评分均较术前明显改善(P0.05),但术后两组间VAS评分及ODI评分差异无统计学意义(P0.05)。依据末次随访疗效,按照改良Macnab标准评定,PELD组优良率95.2%,FD组优良率87.5%,差异无统计学意义(P0.05)。PELD组与FD组相比,手术时间较长、出血量少、术后住院时间短,差异有统计学意义(P0.05)。[结论]针对硬膜外游离腰椎间盘突出症,依据其特有分型与分区恰当选用i-PTED及c-PTED可实现神经根的彻底减压,获得与FD手术相同疗效,扩大了PELD治疗腰椎间盘突出症的手术适应证。同时,相对于FD手术,PELD可在局麻下以更加安全、创伤更小的方式摘除游离于硬膜外的椎间盘组织。
[Abstract]:[objective] based on the classification and division of free nucleus pulposus, to explore the surgical method of removing free epidural intervertebral disc and to evaluate the (PELD), of lumbar discectomy under percutaneous endoscope. Surgical efficacy of (FD) in the treatment of epidural free lumbar disc herniation. [methods] A retrospective analysis was made on 37 cases of these patients admitted from August 2013 to March 2015. FD group consisted of 16 patients, 5 of whom were treated with expanded fenestration. 11 patients in area 2 and 3 underwent routine FD operation. PELD group consisted of 21 patients, 4 of whom were treated with contralateral intervertebral foramen endoscope lumbar discectomy (c-PTED), among which 4 patients with nucleus pulposus free in area 1 and 4 were treated with transforaminal lumbar discectomy (c-PTED). 17 patients in area 2 were treated with conventional ipsilateral interforaminal discectomy (i-PTED). Visual analogue scale (VAS), modified Macnab scale and Oswestry dysfunction index (ODI) were used to evaluate the curative effect of the operation. The difference of operation time, blood loss and postoperative hospitalization time between the two groups was analyzed and compared. [results] the patients in both groups were followed up for 15 ~ 18 months with an average of 16.3 months. Postoperative lower limb pain VAS score and ODI score were significantly improved compared with the preoperative (P0.05), but there was no significant difference between the two groups in VAS score and ODI score (P0.05). According to the result of the last follow-up, according to the modified Macnab standard, the excellent and good rate of the PELD group was 95.2% and the excellent and good rate of FD group was 87.5%. There was no significant difference between the two groups (P0.05 compared with the FD group, the operation time was longer and the amount of bleeding was less in the). PELD group. Postoperative hospitalization time was short, the difference was statistically significant (P0.05). [conclusion] in view of epidural free lumbar disc herniation, i-PTED and c-PTED can be used to decompress the nerve root according to its special classification and proper zoning, and the same curative effect can be obtained with FD operation. The surgical indications of PELD for the treatment of lumbar disc herniation were expanded. At the same time, PELD can be removed from the epidural intervertebral disc in a safer and less invasive manner under local anesthesia than with FD.
【作者单位】：滨州医学院附属医院;山东滨州市人民医院;
【基金】：山东省医药卫生科技发展计划项目(编号:2013WS0300)
【分类号】：R687.3

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