摘要
目的 探讨经皮激光椎间盘减压术（PLDD）治疗多节段腰椎间盘突出症的临床策略及疗效.方法 2005年12月至2008年12月收治56例多节段腰椎间盘突出症患者.局部麻醉下,应用Nd：YAG激光治疗,术中在数字减影血管造影（DSA）机透视下定位,光纤由浅入深插入烧灼,每次发射1 s,间歇1 s,单节段激光总量400～800 J.于术前、术后3个月进行视觉模拟疼痛量表（VAS）及奥斯维斯失能指数（ODI）评分,末次随访时采用改良Macnab标准评价临床疗效.结果 56例患者随访6～36个月,平均18个月,ODI评分由术前的（31.10±2.92）分改善至术后的（11.80±2.62）分（t=3.067,P＜0.01）;VAS评分由术前的（7.00±1.41）分改善至术后的（3.00±0.81）分（t=2.802,P＜0.01）.优36例,良10例,可8例,差2例,优良率82.1%（46/56）.无椎间盘感染、腰大肌血肿、神经根和血管损伤等并发症.结论 PLDD治疗多节段腰椎间盘突出症临床疗效良好,手术安全,耗时短,术后恢复快.
Objective To investigate the efficacy and strategy of percutaneous laser disc decompression （PLDD） for patients with multisegmental lumbar disc herniation. Methods Between December 2005 and December 2008,a total of 56 patients with multisegmental lumbar disc herniation underwent PLDD. Under local anesthesia, the operation was performed using Nd：YAG laser. A digital subtraction angiography （DSA） system was employed to guide the surgery,insert burning, each 1 s, pulse intermission gasification 1 s, single segment laser total 400-800 J. In preoperative and postoperative 3 months visual analogue scale（VAS） and Oswestry disability index （ODI） scores of times during followed up,Macnab standard to assess the clinical curative effect. Results The patients were followed up for 6 - 36 months （mean 18 months）. The ODI improved from （31.10 ±2.92） scores to （11.80 ±2.62） scores （t=3.067,P 〈0.01 ）. The VAS also showed postoperative improvement of pain compared with preoperative findings （7.00 ± 1.41 ） scores vs （3.00 ± 0.81 ） scores （t= 2.802,P 〈0.01 ）. According to the Macnab standard, 36 patients achieved excellent outcomes, 10 were good, 8 were fair, and 2 were poor. The rate of excellent and good outoomes was 82. 1% （46/56）. No patient had postoperative complications. Conclusions PLDD is effective and safe for patients with multisegmental lumbar disc berniation. The cases recover quickly after the operation, because the procedure is minimally invasive.
出处
《中国医师进修杂志》
2010年第14期3-5,共3页
Chinese Journal of Postgraduates of Medicine
基金
河北省卫生厅资助医学适用技术跟踪项目（GL200615）
关键词
椎间盘移位
激光
减压术
外科
Intervertebral disc displacement
Lasers
Decompression,surgical
