[1]邵水霖* 王加旭 张乐乐 高博 李海侠 黄世博 吴继功.经皮侧路椎间孔镜治疗上突出型腰椎间盘突出症[J].中国微创外科杂志,2020,01(9):838-842.
　Shao Shuilin,Wang Jiaxu,Zhang Lele,et al.Treatment of Migrated Upwards Lumbar Disc Herniation With Percutaneous Endoscopic Lumbar Discectomy[J].Chinese Journal of Minimally Invasive Surgery,2020,01(9):838-842.
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经皮侧路椎间孔镜治疗上突出型腰椎间盘突出症()
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《中国微创外科杂志》[ISSN:1009-6604/CN:11-4526/R]

卷:
01
期数:
2020年9期
页码:
838-842
栏目:
短篇论著
出版日期:
2020-09-25

文章信息/Info

Title:
Treatment of Migrated Upwards Lumbar Disc Herniation With Percutaneous Endoscopic Lumbar Discectomy
作者:
邵水霖* 王加旭 张乐乐 高博 李海侠 黄世博 吴继功
（战略支援部队特色医学中心脊柱外科全军脊柱外科中心，北京100101）
Author(s):
Shao Shuilin;  Wang Jiaxu;  Zhang Lele;  et al.
Department of Spinal Surgery, PLA Strategic Support Force Characteristic Medical Center, Spine Center of PLA, Beijing 100101, China
关键词:
腰椎间盘突出症; 经皮椎间孔镜腰椎间盘切除术
Keywords:
Lumbar disc herniation; Percutaneous endoscopic lumbar discectomy
文献标志码:
A
摘要:
目的探讨经皮侧路椎间孔镜腰椎间盘切除术（percutaneous endoscopic lumbar discectomy, PELD）治疗上突出型腰椎间盘突出症的可行性。 方法2014年2月~2019年10月应用经皮侧路椎间孔镜治疗上突出型腰椎间盘突出症12例，取俯卧位，局麻下经后外侧入路，经皮穿刺安置工作通道，于椎间孔下摘除突出间盘髓核、解除神经根压迫。术后卧床4~6 h戴支具下地活动。比较术前后腰腿痛视觉模拟评分(Visual Analogue Scale，VAS)、Oswestry功能障碍指数(Oswestry Disability Index，ODI)，采用改良 MacNab 标准评价患者末次随访时疗效。结果12例顺利完成手术，平均手术时间 75 min（50~100 min），平均术中出血5 ml（2~10 ml）。术中无脊髓、神经、硬膜囊、血管及毗邻脏器损伤,术后无发热、感染、大小便功能障碍等。平均住院2.5 d（1~5 d）。12例随访6~34个月，平均18.5月。术前腰痛 VAS 评分中位数3(2~5)分，显著高于术后3个月1(0~3)分和末次随访时0(0~2)分(P<0.05)，术后3个月与末次随访腰痛无显著性差异（P=0058）；术前腿痛 VAS 评分中位数5.5(4~8)分，显著高于术后2(1~3)分、术后3个月1(0~2)分和末次随访时0(0~2)分(P<0.05)。术前ODI(71.2±2.7)%，显著高于术后3个月(12.3±0.5)%和末次随访时(9.1±0.2)%(P均=0000)，术后3个月ODI显著高于末次随访(P=0.000)。按改良MacNab标准，末次随访优良率91.7%（11/12）。结论侧后路PELD治疗上突型腰椎间盘突出症效果满意，良好的穿刺、置管是手术成功的关键。
Abstract:
ObjectiveTo investigate the feasibility of percutaneous endoscopic lumbar discectomy (PELD) in the treatment of migrated upwards lumbar disc herniation.MethodsA total of 12 patients with migrated upwards lumbar disc herniation were treated with PELD from February 2014 to October 2019. Under local anesthesia, a posterolateral approach was used under prone position, and a working channel was placed through percutaneous puncture. The herniated nucleus pulposus of intervertebral disc was removed beneath the intervertebral foramen to relieve nerve root compression. The patients were bedridden for 4-6 hours after operation, and they were put on brace to get out of bed. The Visual Analogue Scale (VAS), Oswestry Disability Index (ODI), and modified MacNab standard were used for evaluation before and after operation.ResultsAll the 12 cases were successfully operated with PELD. The operation time was 50-100 min (mean, 75 min), the volume of bleeding was 2-10 ml (mean, 5 ml), and the inhospital stay was 1-5 d (mean, 2.5 d). There was no injury of spinal cord, nerve, dural sac, blood vessel or adjacent organs during the operation. There was no fever, infection, or dysfunction of urination and defecation. All the cases were followed up for 6-34 months (mean, 18.5 months). The median VAS scores of lumbar pain were 3 (2-5) points before operation, which were significantly higher than 1 (0-3) points at 3 months after operation and 0 (0-2) points at the last followup (P<0.05). There was no significant difference between 3 months after operation and the last followup (P=0.058). The median VAS scores of leg pain were 5.5 (4-8) points before operation, which were significantly higher than 2 (1-3) point after operation, 1 (0-2) points at 3 months after operation and 0 (0-2) points at the last followup (P<0.05). The ODI before surgery ［(71.2±2.7)%］ was significantly higher than that at 3 months after surgery ［(12.3±0.5)%］ and at the last followup ［(9.1±0.2)%, all P=0.000］. The rate of excellentandgood results was 91.7% (11/12) at the last followup according to the modified MacNab standard.ConclusionsTreatment of migrated upwards lumbar disc herniation with PELD has satisfactory outcomes. Good puncture and catheterization are the key to the success of the operation.

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备注/Memo

备注/Memo:
*通讯作者，Email:550766084@qq.com
更新日期/Last Update: 2020-12-09