摘要
目的回顾性分析经皮椎间孔内镜联合椎间盘造影术诊治腰椎间盘突出症的方法及其临床效果。方法2009年12月至2010年6月行X线正侧位片、过伸过屈动力位片、腰椎计算机断层扫描（CT）及核磁共振成像（MRI）辅助诊断119例腰椎间盘突出症患者，在局部麻醉下先行椎间盘造影术再经皮椎间孔内窥镜下行椎间盘切除术诊治其中男75例，女44例，年龄15～55岁，平均44．8岁；病程3个月一6年，平均9个月。112例为单间隙突出，7例为双间隙突出；侧方型突出82例，旁中央型突出37例；隆起型89例，破裂游离型为30例。排除明显骨性腰椎管狭窄、腰椎滑脱、骨折、炎症、肿瘤等。人院和术后随访时对患者腰腿痛进行视觉模拟评分（VAS）；采用Oswestry功能障碍指数（ODI）评估腰椎功能，用MacNab标准评价疗效。根据术前、术中透视或术中cT影像学结果及内镜下探测定位、操作。结果共做椎间盘造影110次，其中68次（62％）椎间盘诱发试验阳性（10个患者两节段阳性）。20例（18％）临床或影像学有阳性表现，但椎间盘诱发试验结果阴性，其中6次（5％）造影见纤维环破裂、造影剂外溢。12例（11．2％）拟作为阴性对照的无症状椎间盘造影诱发结果阳性。117例患者成功实施手术；1例术中神经根损伤；1例术后感染。5例再次行椎间孔手术后症状缓解。无一例转开放手术。随访平均26个月。VAS由术前的平均6．8分下降到末次随访时的1．8分，差异有统计学意义（P〈0．05）。ODI由术前平均70．2降至末次随访时的19．1。末次随访时优82例（68．9％），良20例（16．8％），可8例（6．7％），差9例（7．6％），优良率85．6％。结论经皮穿刺椎间孔内窥镜技术联合椎间盘造影诊治腰椎间盘突出症中长期疗效满意，总体安全，并发症少，复发率低。
Objective To conduct a retrospective analysis of diagnosis and treatment of lumbar disc herniation by discography and percutaneous transforaminal endoscopic surgery. Methods From December 2009 to June 2010, 119 patients with lumbar disc herniation underwent discography and transforaminal endoscopic surgery under local anesthesia. There were 75 males and 44 females with a mean age of 44. 8 years （range：15 -55）. The mean disease course was 9 months （range：3 -72）. The major symptoms were back pain and/or unilateral sciatica. The mean follow-up period was 26 months. All underwent lumbar radiography, computed tomography （CT） and magnetic resonance imaging （MRI） revealing 112 single level and 7 two-level disc herniations. There were 82 lateral and 37 para-medial disc herniations. Eight-nine patients had protruded discs while 30 had prolapsed and sequestered discs. There were no obvious lumbar stenosis, spondylolithesis, fracture, infection or tumor cases. The preoperative and postoperative visual analogue scale（ VAS）were used to evaluate the sciatica and/or back pain. The outcomes were evaluated by Oswestry disability index（ODI） and the Maenab score. Precise orientation and operation was performed under the guidance of pre-operative imaging, intra-operative fluoroscopy or CT and endoscopic exploration. Results Among them, 117 cases had the surgery performed successfully. The mean operative duration was 85 rain （range：35- 85 ）and the mean blood loss 13 ml （range： 1 -50）. One patient had L5 nerve root injury complicated with paraesthesia and weakness of the affected lower extremity and was relieved gradually after conservative treatment for over 3 months. Another one complicated with postoperative intradiscal infection was referred to another institution and lost follow-up thereafter. Five cases had no improvement at 6 months after the first surgery and were re-operated endoscopically. No one had a conversion into open surgery. They were followed up for a mean period of 26. 1 months （ range ：25 - 27）. Five patients lost follow-up. VAS improved statistically significantly from preoperative 6. 8 to postoperative 1.8 （ P 〈 0. 05 ）. ODI decreased from preoperative 70. 06 to 19.09 at the last follow-up. The Macnab results were excellent （ n = 82, 68.9% ）, good （n =20, 16. 7% ）, fair （n =8, 6. 7% ） and bad （n =9, 7＋ 7% ） （including all patients lost to follow- up）. And the excellent-to-good rate was 85.6%. Conclusion With fewer complications and a low recurrence rate, percutaneous transforaminal endoscopic surgery is safe and efficacious in the treatment of lumbar disc herniation.
出处
《中华医学杂志》
CAS
CSCD
北大核心
2012年第47期3350-3353,共4页
National Medical Journal of China
关键词
椎间盘移位
腰椎
内窥镜
外科手术
最小侵入性
Intervertebral disc displacement
Lumbar vertebrale
Endoscopeas
Surgicalprocedures, minimally invasive
